Outcome of the Neuropathic Diabetic Foot Ulcers, Wagner's Grade 1 & 2, Treated by Total Contact Cast

Abstract

Objective: To assess the outcome of the neuropathic diabetic foot ulcer, Wagner’s grade 1 & 2, treated with total contact cast.

Methods: This study was conducted between 02 years from January 2013 to December 2015. Number of patients with grade 1 and 2 of the Wagner’s classification were 34. After debridement of ulcers and sterile dressing, total contact cast was applied. The cast was changed after every 02 weeks till ulcer’s healing. Cast failure labeled when there was no decrease in ulcer size in between 04 consecutive weeks in cast or the ulcer size or depth increased to higher grade or wound infection or gangrene.

Results: A total 34 patients (28 males and 6 females) with 40 ulcers were selected until the cutoff date, i.e., December 2015. Average mean of patients’ age was 69 years old. Number of patients healed in 02-cast duration on average 30 days was 32 (i.e., 80%), whereas cast failure was 08 (i.e., 20%). Within 40 ulcers, 14 (35%) were superficial ulcer representing Wagner’s grade 1 and 26 (65%) were deep ulcer representing Wagner’s grade 2. Wagner‘s grade 1, all ulcers (i.e., 14) were healed, whereas none of the Wagner’s grade 2 ulcers (i.e., 08) were healed. Based upon anatomical location number of the non-
healed ulcer was only 1 (i.e 2.5%) on heel, and were 03 (i.e., 7.5%) under first metatarsal head in patients with diabetes of more than 10-years duration.

Conclusion: The TCC was effective in treating the Wagner’s grade 1 & 2 neuropathic diabetic foot ulcers of recent onset.

Key words: Diabetes mellitus, neuropathic diabetic foot ulcer, total contact cast.