Off-Loading Total Contact Cast in Combination with
Hydrogel and Foam Dressing for Management of
Diabetic Plantar Ulcer of the Foot
Tanawat Vaseenon MD*,
Songwut Thitiboonsuwan MD*, Chaiyarit Cheewawattanachai MD*,
Punngam Pimchoo MSc*, Areerak Phanphaisarn BSc*
Affiliation :
* Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : The total contact cast is considered to be an effective method of off-loading a diabetic non-infected pressure
ulcer. However, complications have been reported in 1 to 15% of cases, e.g. prolonged healing of the ulcer. Debridement
with modern dressings has been reported to be effective in promoting wound healing; however, there have been few reported
studies of the combination of modern dressings with the cast.
Objective : To evaluate the effectiveness of a combination of treatments on healing rates in diabetic non-infected plantar
ulcer of the foot.
Material and Method: This retrospective study with prospective data collection was conducted between September 2010
and August 2012. Twenty diabetic patients with plantar neuropathic ulcer were treated using a combination of a contact
cast plus hydrogel and foam dressings. The size and location of the ulcer, ulcer healing, foot deformities and complications
were evaluated.
Results : Of 21 ulcers, 20 (95.2%) healed completely in a mean time of 30.1 days (range 14 to 70 days). Healing times for
forefoot and midfoot ulcers were 22.6 and 26.8 days, respectively, which is significantly shorter than the 51.7 days for heel
ulcers. One patient who had an unhealed ulcer developed a severe infection two months after treatment, which necessitated
below the knee amputation. There were three cases of recurrence of the ulcers after casting.
Conclusion : Off-loading casting combined with modern dressings had a high rate of healing in short-term treatment of
diabetic non-infected pressure ulcers. Recurrence of ulcers and new site abrasions were common complications; those
complications may have been caused by association with bone deformity or improper footwear.
Keywords : Off-loading, Total contact cast, Diabetes, Ulcer, Hydrogel, Foam dressing
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