Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP 3rd, Drury DA, Rose SJ, et al.
Diabetes care. Date of publication 1989 Jun 1;volume 12(6):384-8.
1. Diabetes Care. 1989 Jun;12(6):384-8.
Total contact casting in treatment of diabetic plantar ulcers. Controlled
clinical trial.
Mueller MJ(1), Diamond JE, Sinacore DR, Delitto A, Blair VP 3rd, Drury DA, Rose
SJ.
Author information:
(1)Irene Walter Johnson Rehabilitation Institute, Washington University School of
Medicine, St. Louis, Missouri 63110.
Comment in
Diabetes Care. 1989 Oct;12(9):661.
This study compared the treatment of total contact casting (TCC) with traditional
dressing treatment (TDT) in the management of diabetic plantar ulcers. Forty
patients with diabetes mellitus and a plantar ulcer but with no gross infection,
osteomyelitis, or gangrene were randomly assigned to the TCC group (n = 21) or
TDT group (n = 19). Age, sex, ratio of insulin-dependent diabetes mellitus to
non-insulin-dependent diabetes mellitus, duration of diabetes mellitus, vascular
status, size and duration of ulcer, and sensation were not significantly
different between groups (P greater than .05). In the experimental group, TCC was
applied on the initial visit, and subjects were instructed to limit ambulation to
approximately 33% of their usual activity. Subjects in the control group were
prescribed dressing changes and accommodative footwear and were instructed to
avoid bearing weight on the involved extremity. Ulcers were considered healed if
they showed complete skin closure with no drainage. Ulcers were considered not
healed if they showed no decrease in size by 6 wk or if infection developed that
required hospitalization. In the TCC group, 19 of 21 ulcers healed in 42 +/- 29
days; in the TDT group, 6 of 19 ulcers healed in 65 +/- 29 days. Significantly
more ulcers healed (chi 2 = 12.4, P less than .05) and fewer infections developed
(chi 2 = 4.1, P less than .05) in the TCC group. We conclude TCC is a successful
method of treating diabetic plantar ulcers but requires careful application,
close follow-up, and patient compliance with scheduled appointments to minimize
complications.
PMID: 2659299 [Indexed for MEDLINE]
