Healing times of pedal ulcers in diabetic immunosuppressed patients after transplantation.
OBJECTIVE
To compare the healing time of neuropathic plantar ulcers treated by total-contact casting (TCC) in diabetic, immunosuppressed patients after organ transplantation with the healing time of plantar ulcers in control nonimmunosuppressed patients.


METHODS
A case-control design with the control group matched for age, race, sex, body dimensions (height, weight, and body mass index), presence of sensory neuropathy, foot deformity presence and location, and pedal ulcer area and depth.


METHODS
An outpatient physical therapy clinic in a regional tertiary-care hospital and academic medical center.


METHODS
Nine patients with chronic diabetes mellitus and a previous organ transplantation who were currently receiving lifelong immunosuppressive drug therapy were treated for a neuropathic plantar ulcer by means of TCC. Fourteen group-matched control subjects with diabetes mellitus and a plantar ulcer but who had never had an organ transplantation and were not taking immunosuppressive agents were also studied.


METHODS
TCC with partial weight-bearing using an assistive device until ulcers healed.


METHODS
Healing time was defined as the number of days in the total-contact cast until the skin completely closed.


RESULTS
All diabetic foot ulcers healed with casting. Immunosuppressed/transplanted patients healed in a mean time of 111 +/- 25 days; ulcers of control subjects healed in 47 +/- 18 days (p < .05). All patients returned to ambulation using prescribed therapeutic footwear. None of the patients required a lower extremity amputation throughout the follow-up period.


CONCLUSIONS
TCC is a highly effective and rapid method of healing neuropathic pedal ulcers in diabetic immunosuppressed/transplantation patients, although it may take several weeks longer than it would for patients who were not immunocompromised.
Sinacore
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Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA.
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D002370:Casts, Surgical / Q000706:statistics & numerical data; D002908:Chronic Disease; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation; D003929:Diabetic Neuropathies / Q000150:complications; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing