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.