...off-load methods people with neuropathic plantar diabetic foot ulcers.

KEY WORDS

* Total contact cast

* Off-loading

* Diabetic foot ulcer

**********

It well known that complete and constant off-loading of diabetic foot ulcers (DFUs) is mandatory for wound healing. Total contact casts (TCCs) are now widely used for extremity off-loading in people with DFUs and diabetic neuro-arthropathy (Charcot foot). The TCC is considered to be the most effective off-load method (Caravaggi et al, 1999; Sinacore and Mueller, 2001) although comparative studies of TCCs and alternative offloading methods are relatively rare (Mueller et al, 1989; Caravaggi et al, 1999; Ha Van, 2002).

In Russia, traditional methods of offloading DFUs include the half-shoe (for forefoot ulcers) and bed rest, wheelchair or crutch use (for midfoot, rearfoot or bilateral ulcers). These methods were considered as an alternative in this study.

Several modifications to casting technique have been developed, so treatment results can vary widely between studies. We use semi-rigid removable non-windowed fiberglass casts invented by Boogers and Drogmans (2000) made of Softcast and Scotchcast (3M Healthcare, Bracknell) materials. With this technique, inner and outer layers are made of flexible Softcast, and between them two rigid splints made of Scotchcast (one U-shaped and another longitudinal along the sole) are placed. Using such a semi-rigid cast has important advantages over rigid casts (such as the soft edges allowing calf muscle movements) which reduce the risk of, for example, immobilisation complications such as venous thrombosis, joint stiffness, muscle atrophy and pressure sores. Removable casts allow inspection of the wound and daily dressing changes. In the authors' experience, these casts demonstrate better safety than non-removable casts, although efficacy depends on patient concordance.

Even semi-rigid removable casts can cause complications, such as skin breakthrough (with formation of skin erosions [pressure sores] or full-thickness wounds [new ulcers]). In the authors' experience, other complications, such as mycoses and deterioration of wound infection, are much rarer. Our experience has shown that minor skin injuries are often not serious and tend to heal in a short time (usually before the main ulcer). Risk of further complications may be minimised, or even completely eliminated, by adequate training of casting personnel, proper patient...

NOTE: All illustrations and photos have been removed from this article.



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