Total contact cast for neuropathic diabetic foot ulcers.

Objective: To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast (TCC) in terms of percentage of ulcers healed and time to heal.

Study Design: Analytical study.

Place And Duration Of Study: Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, from April 2005 to March 2007.

Methodology: The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast (TCC) was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast.

Results: Thirty four (87.17%) patients were males and 5(12.82%) were females. The mean age was 62 +/- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41(78.84%) healed with TCC in an average 2 casts duration (mean 32 days). There were 11(21.15%) cast failure. Majority (63.63%) of cast failure ulcers were located on pressure bearing area of heel. Most (90%) of the ulcers on forefoot and midsole region healed with TCC (p < 0.001). Longer ulcer duration (mean 57.45 +/- 29.64 days) significantly reduced ulcer healing (p < 0.001).

Conclusion: Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region.