Clinical Relevance for the Veteran

Purpose of Work . The aim of this project was to describe the progression of healing of foot wounds using total contact casting and to evaluate potential factors that might prolong that healing . Subjects/ Procedures . We enrolled 25 persons with foot wounds and casted them until healing using the total contact cast, which is a special type of casting that uses minimal padding in an effort to spread force over a uniform area. Prior to casting, we measured their peak plantar foot pressure using a gait analysis system . Results . We found that persons with high peak plantar pressures took longer to heal . Furthermore, we found that subjects with longer ulcer durations prior to treatment took longer to heal . Relevance to the Veteran Population . The results of this study lend further credence to the clinical importance of elevated peak plantar pressures which, when combined with lack of sensation, can not only help cause a diabetic foot wound, but can hamper its healing . This is a matter of concern to the growing number of veterans facing the sequelae of diabetes. David G. Armstrong, DPM