Current lower extremity casting technologies in complex treatment of the diabetic foot

Abstract

Adequate leg unloading is a key factor of healing of trophic ulcers of the diabetic foot (DF). Total contact casting (TCC) is a method that has recently been used in clinical practice. A study was conducted to examine the effectiveness and safety of TCC versus conventional leg unloading methods, which included 27 patients with the neuropathic DF. TCC and conventional unloading methods ("a low shoe", bed confinement) were used in 14 (Group 1) and 13 (Group 2) patients, respectively. There were no significant differences between the groups in age, gender, the duration and type of diabetes mellitus, and the duration of ulcers. However, in Group 1, trophic ulcers are larger and more frequently located in the middle and posterior parts of the foot (which hampers its unloading). During 6-month therapy, 73 and 46% of the ulcers healed in Groups 1 and 2, respectively. Despite the larger sizes of ulcers in Group 1, the healing time did not virtually differ (109 and 111 days, respectively). Thus, TCC was more effective than conventional unloading methods. Slower trophic ulcer healing in the presence of inadequate unloading more commonly caused severe complications that total contact cast wearing.