Prospective analytical study of assessment of off loading by Total Contact Cast in treatment of non healing plantar ulcers in anaesthetic foot.

BACKGROUND: Chronic planter ulcer, also known as trophic ulcer, shows no tendency towards healing. It is usually seen in sensory deficient foot. The clinical result of a sensory, motor or autonomic loss of a nerve function is frequently the same--ulceration, although the exact cause may vary. The treatment principle involves dressing and avoiding pressure on the ulcerated site called 'offloading' and patient education for prevention.

AIM OF THE STUDY: To determine the outcome of non-healing planter ulcers in an anaesthetic foot treated with offloading, total contact casting (TCC), in terms of rate and duration of healing and percentage of ulcers healed based on improvement of Wagner's grading with respect to the clinical profile of the patient.

METHOD: Detailed examination of the patients was done, and neuropathic foot confirmed. Surgical debridement of the ulcer was done to take off all the necrotic tissues, periwound callus, and infected material down to viable tissues. Once the ulcer became clean, a total contact cast was applied with a walking iron for ambulation. TCC was renewed every 2 weeks and rate of healing was assessed.

RESULT: 80% of the cases healed within 8 weeks, healing defined by complete re-epithelisation of wound. Average duration of healing of an ulcer was 6.73 ±1.92 weeks.

LIMITATIONS OF THE STUDY: Small sample size and the lack of control subjects for comparison.

CONCLUSION: Offloading with total contact casts is believed to be the gold standard method with better and faster healing rates.