Full-time Cast AIDS Healing of Diabetic Ulcers

Wearing the cast can prevent amputations

Diabetics often develop skin ulcers on the bottom of their feet, and if these sores do not heal properly, amputation may be required to save the patient’s life. A new study shows that while wearing a cast full-time on an affected foot aids ulcer healing and can prevent such drastic outcomes, many subjects don’t wear the cast as directed.

Foot ulcers develop in more than one out of six diabetics, partly because they develop nerve damage that prevents them from feeling pain in their feet, even when there is an injury or infection.

In spite of the best treatment with surgery, antibiotics and other new drugs and bandage materials, the sores sometimes don’t heal. Nonhealing, infected ulcers are the cause of about 80% of foot amputations in diabetics. For that reason, doctors usually prescribe devices, such as casts or a half shoe, to be worn on the affected foot to take pressure off the ulcer.

In the journal Diabetes Care, a team led by Dr. David G. Armstrong, a surgeon at the Southern Arizona Veterans Affairs Medical Center in Tucson, reports that patients don’t wear these devices nearly as much as they should.

In a study of 20 patients treated with a removable cast walker, they gave the patients two pedometers, an instrument that registers each step the person takes. The patients wore one pedometer at their waist 24 hours a day for 1 week. The second pedometer was attached to the cast walker.

To the doctors’ surprise, nearly three quarters of the steps patients took each day were taken without wearing the cast. In fact, only six patients wore the cast during more than half of their total activity.

Dr. Lawrence A. Lavery, a podiatrist at Scott and White Hospital in Temple, Texas said that, "many patients believe that they only need to wear the removable cast when they’re walking outside.” But most of their time is spent walking in their own homes, and they don’t realize the danger because their foot doesn’t hurt.

"You should not take a step without the foot being protected, whether you’re in the house or out of house," he stressed. "You can take the cast off when you shower and when you’re sleeping. But otherwise, any time your foot is bearing weight, even if you get up at night to go to the bathroom, you need to protect that foot."

He acknowledges that the cast is inconvenient; that it slows a person’s walking, makes it difficult to walk up and down stairs, and can be uncomfortable. "But it’s not nearly as uncomfortable or inconvenient as having to wear a prosthetic leg for the rest of your life," he reminds patients. SOURCE: Diabetes Care September, 2003.