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Clinical Research

(CR-011) Comparing the use of Soft Total Contact Cast and hard Shield Total Contact Cast in the Management of Diabetic Foot Ulcer.

Lalasa Doppalapudi, MBBS – Resident, PGY 2, Internal medicine, Mercy Hospital, Fort Smith; nkolika Nwankwo, MbbCh – Resident, PGY 2, Internal medicine, Mercy Hospital, Fort Smith
Introduction: It is estimated that about 26 million people annually have diabetic foot ulcers (DFU) and 130 million of people are at risk of developing DFUs with peripheral neuropathy. About 4% to 10% of diabetic patients developed foot ulcers.  If untreated, diabetic foot ulcers can lead to amputation. Total contact casts are currently the standard of care. However, limitations including complications like falls, new wounds, cost, complexity, time and commitment. 

Methods:

Using Epic slicer dicer, 180 patients with DFUs were treated at our clinic between 6/1/2022-12/31/2022. Of the 180, 25 patients who were treated with soft contact cast were randomly selected. After reviewing the charts, 11 patients and 13 wounds are reviewed for our study. Inclusion criteria were:  





  1. Diabetic foot ulcers in adult patients of all genders with superficial/subcutaneous ulcers defined by Grade I Wagner ulcer classification system. 






 Exclusion criteria include: 





  1. All ulcers of grade II, III, IV, V of Wagner’s grading 








  1. Underlying osteomyelitis  











  1. Ischemic ulcers  








  1. Noncompliance 








  1. Ulcers treated with total contact casts. 






Our primary endpoint was to compare the mean healing time of total soft contact cast (TSCC) with the current mean healing time of total contact cast (TCC), 8.4 weeks based on a study by Vierhout et al.  


Our secondary endpoint was the percentage of complications including new ulcer formation, falls, infections with soft contact cast. We calculated the student t-test using the average healing time of our TSCC and TCC. 



Results: In our analysis, we calculated a mean healing time of 5.84 ± 6.2 weeks with a p-value of 0.08. This is comparable to 8.4 weeks with TCCs. Of the 11 patients, 18% (2 patients) developed 3 new wounds. No falls or new infections were observed in any of the patients. 

Discussion: Our findings show no statistically significant difference (P=0.08) in mean healing times with TSCC compared to TCC. We propose that treatment with TSCCs is comparable to the current standard of care (TCC) in treatment of superficial DFUs with fewer complications. 

Trademarked Items:

References: Vierhout BP, Visser R, Hutting KH, El Moumni M, van Baal JG, de Vries JPM. Comparing a non-removable total contact cast with a non-removable softcast in diabetic foot ulcers: A retrospective study of a prospective database. Diabetes Res Clin Pract. 2022 Sep;191:110036. doi: 10.1016/j.diabres.2022.110036. Epub 2022 Aug 10. PMID: 35963371.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. Ann Med. 2017 Mar;49(2):106-116. doi: 10.1080/07853890.2016.1231932. Epub 2016 Nov 3. PMID: 27585063.

Bus SA, Armstrong DG, Gooday C, Jarl G, Caravaggi C, Viswanathan V, Lazzarini PA. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36.