Background: Although total contact casts are highly effective in the
treatment of plantar ulcerations in patients with diabetes mellitus, they are
not widely used. One reason for this lack of acceptance may be the difficulty
in complying with an initial period of non-weight-bearing, as is generally
recommended by physicians. We performed this study to assess the effects of
early weight-bearing on the healing rates of plantar ulcers in patients with
diabetes who were wearing a total contact cast.
Methods: Forty patients with diabetes mellitus who had a noninfected
forefoot or midfoot ulcer were treated with total contact casts until healing
or for thirteen weeks. The patients were instructed to bear no weight on the
cast for forty-eight hours after it was applied. Using an embedded step
counter, we measured the number of steps taken during the first twenty-four
and forty-eight hours, the first week, and each subsequent two-week period
after application of the cast. We removed the cast, measured the radius of the
ulcer, and then reapplied the cast at the end of the first week and of each
subsequent two-week period after cast application until the ulcer healed or
for thirteen weeks. We then determined the effect of the number of steps
during various time intervals on the rate of ulcer healing (defined as a
change in the ulcer radius).
Results: Most patients walked on the cast in the immediate
postoperative period. The effects of modest amounts of early weight-bearing on
ulcer healing rates appear negligible. Only excessive walking during the first
twenty-four or forty-eight hours after cast application is likely to prolong
the duration of cast treatment.
Conclusions: Moderate early weight-bearing retards healing of
plantar ulcers only minimally in patients with diabetes mellitus treated with
total contact casts. Allowing patients to walk immediately after placement of
a total contact cast may improve their acceptance of this form of therapy.
Level of Evidence: Therapeutic study, Level II-1
(prospective cohort study). See Instructions to Authors for a complete
description of levels of evidence.