Casting of Recurrent Diabetic Foot Ulcers
Effective and safe?
- Marrigje H. Nabuurs-Franssen, MD1,
- Maya S.P. Huijberts, MD, PHD1,
- Ron Sleegers2 and
- Nicolaas C. Schaper, MD, PHD1
- 1Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands
- 2Casting Clinic, University Hospital Maastricht, Maastricht, the Netherlands
- Address correspondence and reprint requests to Marrigje H. Nabuurs-Franssen, MD, Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, Netherlands, E-mail: m.nabuurs-franssen{at}intmed.unimaas.nl
With appropriate wound care and biomechanical off-loading, 80–90% of neuropathic foot ulcers can heal (1). Unfortunately, many ulcers recur (2), and recurrence rates up to 70% have been reported (3–5). Little information is available on the management and outcome of these ulcers. In addition, it is unclear how to approach a patient for whom customized shoes fail to prevent ulceration and whose repetitive ulceration could result in progressive scar formation and impaired wound healing. The total contact cast (TCC) is currently seen as the gold-standard treatment of neuropathic ulcers (1,6,7), but the efficacy and safety of repeated treatment is unknown. For this reason, the present study was undertaken to determine whether repeated casting in patients with recurrent foot ulceration remains effective and is not associated with unwanted complications.
RESEARCH DESIGN AND METHODS
A prospective data collection study (from 1999 to 2003) was performed in which diabetic patients with polyneuropathy and a first or recurrent foot ulcer in whom off-loading was indicated but not possible with simple measures (e.g., felt) were included. All patients were evaluated and graded according to the PEDIS system and were treated with a TCC, as previously described by Nabuurs-Franssen and Schaper (8). Exclusion criteria were critical limb ischemia and infection …
