Management of neuropathic ulceration

Patients with diabetes who develop neuropathic foot ulcers are often managed with prolonged bed-rest or given a total contact cast. As these methods are not ideal for many patients, we examined a boot cast as an alternative approach to treating intractable neuropathic ulcers. Fourteen diabetic patients with a total of 16 neuropathic ulcers have been treated. The boot cast is a fibreglass, removable cast, tailor-made for individual patients. For treatment of neuropathic ulcers, a window is cut over the area of the ulcer site to reduce weight-bearing pressure. Despite the long pre-existing duration of the ulcers studied (mean 912 days), ulcers that reached 100% healing did so by 130 days. The mean period in which there has been no recurrence to date is 218 days. The boot cast was found to be an effective treatment in the management of diabetic foot problems. It allows patients to remain ambulant and reduces risk factors for amputation.