A COMPARATIVE STUDY ON THE EFFICACY OF TOTAL CONTACT CASTING (TCC) VERSUS PATELLAR TENDON BEARING (PTB) CASTING WITH BOHLER'S WALKING IRON IN TREATMENT OF NEUROPATHIC PLANTAR FOOT ULCER

Abstract

Introduction: Neuropathic plantar ulceration is one of the serious hazards to the person with anaesthetic feet. The entire history of a plantar trophic ulcer is dominated by mechanical factors. Apart from Total Contact Casting (TCC) there are several offloading techniques and custom-made orthoses readily available including a simple customized Patellar Tendon Bearing (PTB) cast, PTB cast along with Bohler’s walking iron (BWI) with may enhance the mobility, increasing patient’s self-esteem and finally reduce the disability.

Material and methods: In this prospective parallel group randomized controlled open level trial, conducted in the Department of Physical Medicine and Rehabilitation, IPGME&R, SSKM Hospital, Kolkata between 15th January, 2012 to 14th July, 2013 (Eighteen months) 54 (27 in each group) patients with neuropathic plantar foot ulcer, residents of Kolkata and surrounding districts, attending the Physical Medicine and Rehabilitation OPD at IPGME&R, 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: The combined results of these studies yields an average rate of successful healing of 75.5% after an average of 38.7 days in the cast but for the lack of literature we found difficulty to compare our results in case of PTB casting with Bohler’s walking iron as it has not been extensively studied like TCC. The results of our study indicate that pressure off-loading using the TCC and PTB casting with Bohler’s walking iron are equally effective in the treatment of neuropathic plantar foot ulcer.

Conclusion: Both TCC and PTB casting with Bohler’s walking iron are helpful to reduce ulcer depth, and ulcer area which are statistically significant (p value < 0.001). Approximately 30% of the ulcer healed quite well in both the groups after the period of 3 weeks of treatment but majority of the ulcer (85.2% in TCC group & 77.8% in PTB casting with Bohler’s walking iron group) healed at the end of the study by both form of treatment.