Total-contact casts effective in treatment of foot wounds in diabetics

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Last Updated: 2001-07-27 15:44:43 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – A study demonstrates for the first time that total-contact casts (TCCs), considered the "gold standard" for diabetic foot ulcer treatment, promote faster results and a greater rate of healing than two other commonly used off-loading modalities.

Dr. David G. Armstrong and colleagues, from the Southern Arizona Veterans Affairs Medical Center in Tucson, randomized 63 patients with superficial noninfected, nonischemic diabetic plantar foot ulcers to one of three treatments: TCC, removable cast walker (RCW) or half-shoe. Outcomes were measured at 12 weeks or at the time of wound healing, whichever came first.

According to the team's report in the June issue of Diabetes Care, the proportion of patients who were healed was significantly higher in the TCC group, 89.5%, than in the RCW group, 65.0% (p = 0.026). The proportion who were healed in the half-shoe group was 58.3%. There was also a significant difference in time to healing between patients treated with a TCC versus RCW (p = 0.033) or half-shoe (p = 0.012).

Dr. Armstrong's team notes that patients with the TCC cast were "significantly less active than those treated with the half-shoe," but otherwise there were no significant differences between groups.

"TCCs are effective for a number of reasons in addition to their ability to mitigate pressure. They may help to reduce or control edema and potentially protect the foot from infection," Dr. Armstrong and colleagues comment. They note that "the most important attribute of the TCC may be its ability to 'force compliance'," by limiting physical activity and being difficult for patients to remove.

Diabetes Care 2001;24:1019-1022.

-Westport Newsroom 203 319 2700

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