Removable fiberglass de-loading cast for the management of neuropathic plantar ulceration of the foot.
BACKGROUND
Neuropathic plantar ulceration of the foot is treated by de-loading the ulcer. The total contact cast is considered to be the gold standard, but it is a labor-intensive procedure and frequent cast changes are needed.


OBJECTIVE
To describe an alternative de-loading method using a fiberglass removable walking cast.


METHODS
This prospective uncontrolled study comprised 24 diabetic and non-diabetic patients with a single planter neuropathic ulcer. Exclusion criteria included the presence of osteomyelitis or cellulites, peripheral vascular disease, severe foot or leg edema, more than one ulcer on the treated foot, ulcers on the other foot, visual problems, gait instability, and personality or psychiatric problems. All patients were treated with the removable fiberglass de-loading cast. At each weekly follow-up visit the cast was removed. Data were collected using a clinical report form.


RESULTS
The ulcer healed completely in 21 of the 24 patients treated (87.5%). The mean time for healing was 6.8 weeks (range 3-20 weeks, SD = 4.2). New ulcers developed in six patients (25% of the group).


CONCLUSIONS
The effectiveness and safety of the method is comparable to that of the total contact cast, but is less labor intensive because the cast is manufactured only once and serves for the whole length of treatment. Improving the technique is expected to lower the complication rate.
Tamir
Eran
E
Department of Orthopedic Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel. eranetta@012.net.il
Heim
Mike
M
Siev-Ner
Itzhac
I
D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D004867:Equipment Design; D005260:Female; D016523:Foot Ulcer / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014945:Wound Healing