Vnitr Lek 2005, 51(9):988-994

The effect of removable total contact cast therapy on healing of patients with diabetic foot ulcers, acute Charcot osteoarthropathy and neuropathic fractures.

V. Fejfarová^*, A. Jirkovská, M. Křížová, J. Skibová

Centrum diabetologie, IKEM, Praha přednosta prof. MUDr. Terezie Pelikánová, DrSc.

Removable total contact cast (TCC) is one of the appropriate methods used for lower limb off-loading in patients with the diabetic foot.


The aim of our study:
To assess the effect of TCC therapy on healing of patients with neuropathic foot ulcers, acute Charcot osteoarthropathy and neuropathic fractures.

Methods:
Removable TCC were applied for different indications during the observed period of 20 month: for chronic neuropathic ulcers in 27 patients (group 1; mean age 53.5 ± 8 years, mean diabetes duration 14.8 ± 7 years, mean HbA_1c 8.2 ± 2%), for acute Charcot osteoarthropathy in 35 patients (group 2; mean age 53.9 ± 8 years, mean diabetes duration 16.6 ± 10 years, mean HbA_1c 8.4 ± 2%) and for neuropathic fractures in 12 patients (group 3; mean age 52.8 ± 10 years, mean diabetes duration 14.8 ± 12 years, mean HbA_1c 8.9 ± 2%). Healing criteria for the diabetic foot were: total epithelization for the group 1, clinical improvement of local findings as skin temperature decrease and/or improvement of scintigraphic parameters for the group 2 and total X-ray healing of fracture for the group 3.

Results:
Patients with diabetic foot ulcers were treated by removable TCC for 6 ± 4.2 months, patients with acute Charcot osteoarthropathy for 5.1 ± 4 months and patients with pathological fractures for 3.9 ± 2.6 months on average (NS). The significantly highest percentage of completely healed patients during the observed period was found in the group of patients with neuropathic fractures in comparison with the group of patients with the diabetic foot ulcers and acute Charcot osteoarthropathy (83% vs. 30% vs. 37%, respectively; p < 0.01). Significant improvement of foot ulcers was found in 12 patients from 19 non-healed patients with diabetic foot ulcers during TCC therapy (ulcer size 5.6 ± 6.8 vs. 1.56 ± 2 cm2, p < 0.01), 4 patients had the same clinical finding and local worsening was seen in 3 patients with diabetic foot ulcers. 19 patients from 22 non-healed patients with acute Charcot osteoarthropathy had improved local findings and significantly reduced skin temperatures during the observed period (2.74 ± 1.3 vs. 2 ± 1.3 °C; p < 0.05), local findings were worsened in 3 patients. Non-healed neuropathic fractures were found only in 2 patients from this group (17%). TCC complications, which leaded to interruption of TCC therapy, were found in 7 patients from the group 1 (26%), in 3 patients from the group 2 (9%) and in 1 patient from the group 3 (8%); NS.

Conclusion:
Removable TCC is suitable method for lower limb off-loading in patients with the diabetic foot, since this therapy accelerates healing as of acute Charcot osteoarthropathy or neuropathic fractures as of diabetic foot ulcers. Rational indication, education and regular controls are essential for patients with neuropathic foot ulcers, whose have higher risk for development of complications.

Keywords: diabetic foot; total contact cast; off-loading

Received: July 12, 2004; Accepted: February 16, 2005; Published: September 1, 2005  Show citation