Debangshu Bhakat, Saumen Kumar De, Pallab Das, Rathindra Nath Haldar, Subhrajyoti Naskar


Introduction: Neuropathic plantar ulceration is one of the serious hazards to the person with anaesthetic feet who otherwise lead an active life. The
entire history of a plantar trophic ulcer is dominated by mechanical factors. The results of treatment with local applications and dressings were poor
indeed until putting the neuropathic foot in a total contact plaster became the standard treatment. Several offloading techniques eg. Total Contact
Casting (TCC) and custom made orthoses readily available including a simple customized PTB (Patellar Tendon Bearing) cast to the affected limb
and Bohler's walking iron with PTB cast may enhance the mobility, increasing patients self-esteem and finally reduce the disability. This project is a
humble sincere attempt to find out the role of PTB casting with Bohler's walking iron in the treatment of neuropathic plantar foot ulcers.
Material and methods: In this Longitudinal analytical study, conducted in the Department of Physical Medicine and Rehabilitation, IPGME&R,
SSKM Hospital, Kolkata between 15th January, 2012 to 14th July, 2013 (Eighteen months) 27 (n=27) patients with neuropathic plantar foot ulcer,
residents of Kolkata and surrounding districts, attending the Physical Medicine and Rehabilitation OPD at IPGME&R and SSKM Hospital,
Kolkata were included and studied if they fulfilled the inclusion and exclusion criteria after getting Institutional Ethics Committee clearance and
informed written consent.
Results: All the data collected during this study period were analyzed by using statistical software Statistica vertsion 6 [Tulsa, Oklahoma: StatSoft
Inc., 2001] and GraphPad Prism version 4 [San Diego, California: GraphPad Software Inc., 2005] . There was statistically significant
improvement. Studies yielded an average rate of successful healing of 75.5% after an average of 38.7 days. PTB casting with Bohler's walking iron
is effective in the treatment of neuropathic plantar foot ulcer.
Conclusion: Mostly male of 3rd and 4th decade were affected with neuropathic plantar foot ulcer. PTB casting with Bohler's walking iron is
helpful to reduce ulcer depth, and ulcer area which are statistically significant (p value < 0.001). Approximately 30% of the ulcer healed quite well
after the period of 3 weeks of treatment but majority of the ulcer 77.8% healed at the end of the study.


Neuropathic plantar ulceration, Total Contact Casting, PTB (Patellar Tendon Bearing) cast, Bohler's Walking Iron

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