Management of Diabetic Neurotrophic Foot Ulcers with Total Contact Cast: A Serial of 44 Cases

Abstract

Objective: Ulcers related to diabetic neuropathy are the most common problems of insensitive feet. Acute and progressive diabetic foot infections threatening the extremity and even life arise as the result of sudden exacerbation of these mostly chronic lesions. Bone, joint and tendon involvements are present in a big proportion of these diabetic foot lesions. Surgical interventions are almost always required for their treatment. Total contact cast (TCC) is a non-surgical treatment prominenced in the last two decades and became a 'gold standard' treatment modality for management of cases without bone and joint involvement. We have been using TCC for management of neurotrophic ulcers related to diabetes since the beginning of 2000s. In this paper, we aimed to introduce total contact cast technique and present of our outcomes. Material and Methods: The number of the cases with chronic neurotrophic plantar ulcers and had TCC was 44. The cast was removed in the first week as one subject could not tolerate it. The mean age of our cases was 59 years, the mean time of living with diabetes was 20.3 years and mean time of living with ulcers was 27 months. Results: Healing of the wounds were provided in all of our cases. Mean TCC number was slightly above two, we provided healing with a single cast in 14 (32.5%) cases. We experienced cast pinch complications in nine (20.45%) cases. We saw that the ulcer recured at the same site in 11 of 43 cases (25.5%). Conclusion: We believe that information and experiences obtained from these applications will contribute the solution of the problems in this area along with total contact cast being an effective and reliable treatment method in insensible feet.