Paper
Saturday, July 24, 2004
This presentation is part of : Nursing Care Challenges
Initial Weight Bearing in Total Contact Cast: Effect on Diabetic Foot Ulcer Healing
Rita A. Frantz, PhD, RN, FAAN1, Charles L. Saltzman, MD2, Miriam B. Zimmerman, PhD3, Ryan L. Holdsworth, BS2, Susan Beck, BSN2, Heather Hartsell, PhD4, and Kenneth Kesselring, Orthodist2. (1) College of Nursing, The University of Iowa, Iowa City, IA, USA, (2) Department of Orthopaedic Surgery and Rehabilitation, The University of Iowa, Iowa City, IA, USA, (3) College of Public Health, The University of Iowa, Iowa City, IA, USA, (4) Physical Therapy Program, Indiana University, Indianapolis, IN, USA
Learning Objective #1: Describe a method for measuring rate of wound healing
Learning Objective #2: State the relationship between weight bearing immediately following Total Contact Cast application and rate of diabetic foot ulcer healing
Objective: Although effective for healing diabetic plantar ulcerations, total contact casts (TCCs) are not used widely because of patients’ lack of acceptance of initial weight bearing restrictions, a requirement based on the untested assumption that the cast must first harden to prevent deformation and impaired efficacy. This study assessed the effects of early weight bearing on healing rates of diabetic plantar ulcers treated with TCCs.

Design: A prospective, observational design was used.

Population, Sample, Setting, Years: A sample of 31 diabetic patients with non-infected plantar ulcers were recruited over a 20-month period from a diabetic foot clinic patient population. Subjects were followed until healing or 13 weeks of cast immobilization.

Intervention and Outcome Variables: All ulcers were treated with a TCC. Weight bearing was monitored using a step activity monitor incorporated into the cast that recorded steps taken each hour. Rate of healing was expressed as linear advance of the wound (change in radius) computed from acetate ulcer edge tracings measured with a graphic digitizer.

Methods: TCC’s were removed and reapplied after the first week of immobilization and each subsequent two-week period. Patients were provided crutch-walking training and instructed to bear no weight on the cast for 48 hours after application. Number of steps taken between cast changes was downloaded and acetate tracings of the wound were made at each visit.

Findings: Most patients walked on their casts in the immediate period following application. Healing rate was not associated with average steps per day in the first 24 hours, first 48 hours, or the entire period of TCC. Low step activity in the first 24 or 48 hours was not associated with increased rates of healing.

Conclusions: Ulcer healing was not hindered by weight bearing activity immediately following TCC application.

Implications: Weight bearing restriction immediately following TCC application is unwarranted.

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