The total-contact cast for management of neuropathic plantar ulceration of the foot

J Bone Joint Surg Am. 1992 Feb;74(2):261-9.


Seventy-one neuropathic ulcers of the foot in sixty-six patients were treated with the use of a total-contact cast. The ulcers had been present for an average of five months (range, one to twenty-nine months) and were graded according to the Wagner classification; only patients who had grade-I or grade-II lesions were treated with a total-contact cast. The diameter of the ulcer averaged 3.5 centimeters (range, 1.5 to 15.5 centimeters). Sixty-four (90 per cent) of seventy-one ulcers were healed at a mean of five and one-half weeks (range, one to fourteen weeks). A deep infection developed in two patients during treatment. Twenty-two ulcers (31 per cent) recurred within eighteen months after initial healing; nineteen (86 per cent) of them healed after an average of two weeks in a second cast. Recurrent ulceration was usually associated with an underlying fixed deformity or osseous prominence. The total-contact cast provided safe, reliable, and cost-effective treatment for patients who had neuropathic ulcers of the foot.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Casts, Surgical*
  • Female
  • Foot Ulcer / etiology
  • Foot Ulcer / pathology
  • Foot Ulcer / therapy*
  • Humans
  • Male
  • Middle Aged
  • Peripheral Nervous System Diseases / complications*