Total Contact Casts and Diabetic Foot Sores

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Nabuurs-Franssen MH, Sleegers R, Huijberts MSP, et al.: Total contact casting of the diabetic foot in daily practice. Diabetes Care 28:243-247, 2005.

What is the problem and what is known about it so far?

Foot sores (ulcers) develop when nerve damage caused by diabetes keeps a wound or break in the skin from healing. If a doctor does not treat them, these sores can get infected and the foot may even have to be removed with surgery.

Wearing a cast around the foot is one way to help heal foot sores. Total contact casts, which fit around the whole foot and keep weight off the foot when the patient is standing, are the best way to heal sores. But some patients have problems with total contact casts because it's hard to move freely, they are expensive, and the patient must see a specialist. Plus, patients with infected sores risk spreading the infection since a total contact cast keeps the sore from being treated every day. Patients who have partly blocked blood vessels (peripheral arterial disease) in their legs risk getting even more sores.

Why did the researchers do this particular study?

The researchers wanted to study the pros and cons of using the total contact cast to treat foot sores in patients with diabetes.

Who was studied?

The researchers studied 98 patients with foot sores. Many of them -- 90% -- had more than one complication from diabetes, 44% had blocked blood vessels in their legs, and 29% already had infections when the study began.

How was the study done?

Three types of total contact casts were used in the study: a nonremovable cast, a removable cast, and a nonremovable shoe-model cast. Patients received one of the three kinds of casts, and their foot sores were examined once or twice a week until the sores healed. The cast was rated a failure for that patient if the sore did not heal in 4 weeks, if the infection got worse, or if the patient was in too much pain.

What did the researchers find?

Researchers found that all three casts helped heal foot sores at the same rate. Overall, 74 patients had foot sores that healed within 33 days; however, the cast did not work for 22 patients. Three patients had to have their foot removed with surgery.

The researchers also found that most of the patients whose foot sores did not heal were those who had blocked blood vessels in their legs, had a sore for a long time, or had more infections before they started using the cast. Sores on patients' heels were the hardest to cure.

What were the limitations of the study?

This study did not measure whether nonremovable total contact casts, which force patients to keep pressure off the sore, are better than casts that patients can take off.

What are the implications of the study?

Using casts is a good way to help heal foot sores for patients with diabetes. A cast will even help patients with a little bit of blood vessel blockage in their legs and mild infection. But if patients have both blood vessel blockage and an infection, or if they have a sore on their heel, other treatments may work better.

FOR MORE INFORMATION

Foot Complications

The foot care top ten tips. Diabetes Forecast, 61–62, May 2003.