Total Contact Cast for Neuropathic Diabetic Foot Ulcers | [Journal of College of Physicians and Surgeons--Pakistan : JCPSP • 2008]

Author(s):

1. Rajab Ali: Department of Orthopaedic Surgery, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan

2. Asif Qureshi: Department of Orthopaedic Surgery, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan

3. Mohammad Yousuf Yaqoob: Department of Orthopaedic Surgery, Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi, Pakistan

4. Mohammad Shakil: Department of Physiology, Dow University of Health Sciences, Karachi, Pakistan

Abstract:

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.

Page(s): 695-698

DOI: DOI not available

Published: Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 18, Issue: 11, Year: 2008

Keywords:

Neuropathic diabetic foot ulcer Total contact cast Diabetes Foot deformity

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