O1082 THE DIABETIC FOOT -TREATMENT BY TOTAL CONTACT CASTING

Abstract

Introduction: Pressure relief is essential in treating plantar neuropathic ulcers in the diabetic foot. This can be achieved in an excellent way by total contact casting, therefore especially the longstanding, problematic ulcer-nonresponding to common methods (such as insoles, special shoeware etc,) is adressed by this method.A second indication for total contact casting is presented by the acute stage of neuroosteoarthropathy (Charcot’s foot) with or without ulceration. Methods: 19 patients with diabetes type II were treated by total contact casting. The mean age was 55 (46–75) years. Only 4 out of 19 patients were women We found plantar ulcers 12 of the 19 cases, 7 cases had no ulcer, but a Charcot’s foot stage I was present. Most ulcerations were classified as Wagner stage II and III without any sign of infection. The mean duration of casting was 8 (1–22) weeks. All patients were treated in an outpatient-clinc, no admission to the hospital was needed. The method of casting is exactly presented. Results: Complications were seen in only one of the cases due to skin problems.8 of the 12 ulcers healed completely under casting, 4 healed by a mean of 4 weeks later due to further treatment after casting. All the cases of osteoathropathy could be treated until reaching stage II without any progression of the foot-deformity. Conclusions: The total contact cast gives us the possibility to treat patients with plantar neuropathic ulceration and/or Charcot’s foot stage I with the advantage of good plantar pressure reduction and upkeeping the patient’s full mobility at the same time.