Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts

The purpose of this article is to describe the progression of ulcer healing using total contact casts (TCC) and to examine explanatory variables that may influence ulcer healing. We prospectively studied 25 diabetics with grade I (Meggitt-Wagner) plantar ulcers. All subjects received weekly contact cast changes with wound assessment. Following healing, all subjects were fitted with prescription shoe gear. Mean duration of casting until healing was 38.8 +/- 21.3 days. Individuals with pressures over 99 N/cm2 took longer to heal (33.1 +/- 13.0 vs. 53.4 +/- 31.4 days, P = 0.05) and had longer ulcer duration prior to treatment (52.7 +/- 37.2 vs. 180.7 +/- 145.0 days, P = 0.02). Subjects with wound size greater than 8 cm2 took longer to heal (50.2 +/- 26.2 vs. 29.9 +/- 10.6 days, P = 0.02). We conclude that subjects with high plantar pressures and wounds greater than 8 cm2 took significantly longer to heal when uniformly treated with TCC.