Molded double-rocker plaster shoe for healing a diabetic plantar ulcer. A case report.
The purpose of this case report is to document the successful healing of a chronic neuropathic plantar ulcer with the molded double-rocker plaster shoe (MDRPS) in a lower extremity that also had stasis changes and poor blood flow. The patient was a 67-year-old woman with insulin-dependent diabetes mellitus, insensitive feet, a right ankle-arm index of 0.48, and an ulcer beneath the right cuneonavicular joint measuring 0.94 cm2 in area and 2 mm deep. Reported onset of the ulcer was 10 months before referral for physical therapy. The MDRPS was chosen as an alternative treatment to conventional below-knee total contact casting (TCC) because of the stasis changes and fragile skin in the patient's lower extremities. The ulcer healed in 39 days after initiating treatment with the MDRPS. We consider the MDRPS the preferred treatment with those patients with neuropathic plantar ulcers who cannot tolerate the below-knee TCC.
Diamond
J E
JE
Department of Physical Therapy, Irene Walter Johnson Rehabilitation Institute, Washington University Medical School, St. Louis, MO 63110.
Sinacore
D R
DR
Mueller
M J
MJ
D000368:Aged; D002370:Casts, Surgical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D005260:Female; D005534:Foot Diseases / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012775:Shoes; D012883:Skin Ulcer / Q000209:etiology / Q000628:therapy*