title: The total-contact cast for management of neuropathic plantar ulceration of the foot.
abstract: Seventy-one neuropathic ulcers of the foot in sixty-six patients were treated with the use of a total-contact cast. The ulcers had been present for an average of five months (range, one to twenty-nine months) and were graded according to the Wagner classification; only patients who had grade-I or grade-II lesions were treated with a total-contact cast. The diameter of the ulcer averaged 3.5 centimeters (range, 1.5 to 15.5 centimeters). Sixty-four (90 per cent) of seventy-one ulcers were healed at a mean of five and one-half weeks (range, one to fourteen weeks). A deep infection developed in two patients during treatment. Twenty-two ulcers (31 per cent) recurred within eighteen months after initial healing; nineteen (86 per cent) of them healed after an average of two weeks in a second cast. Recurrent ulceration was usually associated with an underlying fixed deformity or osseous prominence. The total-contact cast provided safe, reliable, and cost-effective treatment for patients who had neuropathic ulcers of the foot.
authors.affiliation: Union Memorial Hospital, Baltimore, Maryland 21218.
authors.forename: M
authors.initials: M
authors.lastname: Myerson
authors.forename: J
authors.initials: J
authors.lastname: Papa
authors.forename: K
authors.initials: K
authors.lastname: Eaton
authors.forename: K
authors.initials: K
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D005260:Female; D016523:Foot Ulcer / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications*