Total contact casting in diabetic patients with neuropathic foot ulcerations

This study investigated total contact casting in the treatment of diabetic foot ulcerations and factors affecting the rate of ulcer healing. Twenty-two diabetic patients with foot ulcerations were rated on the basis of age, weight, ulcer size, and ulcer grade. After treatment with total contact casting, 16 patients (72.7%) healed in an average of 38.3 days, 3 refused treatment, 1 developed a small tibial ulceration, and the remainder were discontinued due to excessive edema. A significant (p less than 0.01) t test for differences between means was calculated comparing ulcer duration prior to casting to healing rate during casting. All patient variables were intercorrelated, and significant (p less than 0.01) intercorrelations among patient variables were as follows: age with grade, 0.58; grade with healing time, 0.49; size with healing time, 0.50; age with ulcer size, 0.36; weight with ulcer size, 0.37; age with healing time, 0.32. A multiple correlation of 0.69 (p less than 0.01) was found for age, grade, size, and weight with healing time. Ulcer grade and size contributed most directly to the total multiple correlation; age contributed equally to size, grade, and healing time; and weight contributed primarily to ulcer size. These results suggest the following: 1) total contact casting is an extremely valuable method of treatment for diabetic foot ulcerations, and 2) when using this treatment technique associated factors (ulcer size, ulcer grade, patient age, patient weight) may be utilized to help predict patient healing.