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The Journal of Bone and Joint Surgery, Vol 74, Issue 2 261-269, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
The total-contact cast for management of neuropathic plantar ulceration of the foot
M Myerson, J Papa, K Eaton and K Wilson
Union Memorial Hospital, Baltimore, Maryland 21218.
Seventy-one neuropathic ulcers of the foot in sixty-six patients were
treated with the use of a total-contact cast. The ulcers had been present
for an average of five months (range, one to twenty-nine months) and were
graded according to the Wagner classification; only patients who had
grade-I or grade-II lesions were treated with a total-contact cast. The
diameter of the ulcer averaged 3.5 centimeters (range, 1.5 to 15.5
centimeters). Sixty-four (90 per cent) of seventy-one ulcers were healed at
a mean of five and one-half weeks (range, one to fourteen weeks). A deep
infection developed in two patients during treatment. Twenty-two ulcers (31
per cent) recurred within eighteen months after initial healing; nineteen
(86 per cent) of them healed after an average of two weeks in a second
cast. Recurrent ulceration was usually associated with an underlying fixed
deformity or osseous prominence. The total-contact cast provided safe,
reliable, and cost-effective treatment for patients who had neuropathic
ulcers of the foot.
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