Recurrence of neuropathic ulceration following healing in a total contact cast.

Total contact casting has been clearly shown to be an effective technique in the healing of diabetic neuropathic foot ulcerations. The purpose of this study was twofold: (1) to determine the rate of ulcer recurrence in a large population of patients whose ulcerations had healed in a total contact cast, and (2) to determine the reason for which ulcerations had recurred. A random sample of 102 patients was taken from a much larger population, all of whom had healed in a total contact cast. There were 54 men and 48 women, all of whom were diabetics, averaging 50.5 years of age. These patients had an average wound size of 2.6cm by 1.9cm prior to casting and an average healing time of 33.9 days. At the time the sample was drawn, it had been an average of 25 months since casting for this group. Twenty (19.6%) of the 102 patients had ulcer recurrences since initially healing in a cast. Causes of ulcer recurrence were failure to comply with follow-up foot-wear/foot-care protocol (n = 8), biomechanical faults (n = 5), osteophyte or bone fragment (n = 4), osteomyelitis (n = 5), and Charcot joint (n = 4). Some patients had multiple etiologies.