Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society vol:24 issue:9 pages:680-4
Foot ulcers in patients with diabetes present an increasing burden to healthcare. Total contact cast (TCC) is a well established treatment option for many of these ulcers, but little seems to be known about the final outcome once healing has been reached. The study examined healing and final outcome after TCC treatment among patients with diabetes. During a 22-month period, 15 consecutive patients with a total of 17 ulcers started treatment with a TCC. Three patients (three ulcers) were lost to follow-up (FU). Average FU was 91 weeks. The patients were followed with emphasis on healing, complications during FU, footwear, compliance, and frequency of visits. All ulcers healed, some after additional surgery. During FU, control visits were performed at an average of one visit every 4.7 weeks. Notwithstanding this, a high frequency of ulcer recurrence and/or other complications was noticed. Only four patients out of 12 remained without any new (ulcer) problem during FU. TCC proved to be a very efficient tool to heal neuropathic foot ulcers, but the recurrence rate and frequency of other complications remained very high. These data show how difficult it is to achieve reliable (secondary) preventive general foot care, and to prescribe and manufacture reliable footwear.