Total contact casting of the diabetic foot in daily practice: a prospective follow-up study.
OBJECTIVE
A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.


METHODS
Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.


RESULTS
Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P < 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P < 0.05). Median duration of cast treatment was 34 days. New ulcers, all superficial, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days.


CONCLUSIONS
In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.
Nabuurs-Franssen
Marrigje H
MH
University Hospital Maastricht, Department of Internal Medicine and Endocrinology, P.O. Box 5800, Maastricht 6200 AZ, Netherlands. m.nabuurs-franssen@intmed.unimaas.nl
Sleegers
Ron
R
Huijberts
Maya S P
MS
Wijnen
Wiel
W
Sanders
Antal P
AP
Walenkamp
Geert
G
Schaper
Nicolaas C
NC
D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002370:Casts, Surgical / Q000009:adverse effects; D017719:Diabetic Foot / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents