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dear all,
i have applied five total contact cast for last 6months duration. initial results were found to be surprised. long standing ulcer over period of 10 years also was healed with in two months. all the patients were give modified food wear.
but long term follow-up was discouraging me. almost all the patients developed recurrent ulcer.
how can i prevent this
suresh

 

Hi, unfortunitly this is often common especially with diabetes and the patients inability to feel repeatitive trauma. It can take many modifications of insoles and foot wear to get just the right degree of off loading. The other thing to concider is - is the patient actually wearing the custom foot wear as often they will not wear them except to visit the podiatrist.

 

Suresh

I suspect there are a couple of things that are going wrong here.

Potentially the footwear and its modifcations are incorrect, or there is an absence of a custom orthosis within the shoe also.

Finally, recurrent ulceration may suggest that conservative care will be ultimately be ineffective, particularly if there is significant deformity etc. These patients may ultimately require tendo Achilles lengthening, other forms of tendon balancing, or osseous correction to prevent recurrence.

LL