Ischemic diabetic foot ulcers do respond to total contact casting

There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:

Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
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.
RESEARCH DESIGN AND 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 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.

Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC

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Ischemic diabetic foot ulcers do respond to total contact casting

There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:

Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
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.
RESEARCH DESIGN AND 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 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.

Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC

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Interclinician variation in diabetes foot assessment- a national lottery?

From the latest Diabetic Medicine:

Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses

Discussion here.

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Interclinician variation in diabetes foot assessment- a national lottery?

From the latest Diabetic Medicine:

Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses

Discussion here.

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