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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