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Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 97-102

Effectiveness of removable walker cast in the healing of diabetic neuropathic foot ulcer

1 Department of Orthopedic, Al-Hilla Teaching Hospital, Babylon, Iraq
2 Department of Orthopedic, Al-Imam Al-Sadiq Hospital, Babylon, Iraq

Correspondence Address:
Dr. Yasir Azeez Mohammad
Al-Hilla Teaching Hospital, Babylon
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJBL.MJBL_68_19

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Background: The elevation of the plantar loading has been implicated in the etiology of plantar foot ulceration in individuals with diabetes mellitus (DM) and peripheral neuropathy. Many strategies are used to reduce this load which are regarded as critical for ulceration healing and commonly called offloading. Objective: The objective was to evaluate the effectiveness of the use of a removable cast walker (RCW) in the healing of diabetic neuropathic planter foot ulcerations. Materials and Methods: Twenty-nine adult diabetic patients attending Al-Faiyha General Hospital, Basrah city in Iraq, participated in this cross-sectional (randomized selection) prospective study between August 2014 and September 2015. We relied on clinical features for survey a diabetic neuropathy of affected foot and we proved the diagnosis by nerve conduction study. Assessment of vascularity was done clinically and by Doppler ultrasound study. Surgical debridement was done, and the participants were instructed to wear a RCW on the 2nd day post operation. Follow-up was performed weekly, and the outcome was assessed by complete wound healing. Results: Twenty-nine patients were included in our study and follow-up program. The mean duration of the neuropathic nonischemic ulcers was 7.1 ± 4.3 months. The healing rate was 62.5%, and we found that the total percentage of healing of the ulcers with 1A and 2A classes was 69.0% with a mean duration of 8.45 ± 2.2 weeks. In addition, we observed that the percentage of patients with diabetic neuropathic foot ulceration with an obvious forefoot deformity was 56.5% of all forefoot ulcers, with a healing rate of 76.9%, whereas those without an obvious foot deformity was 43.5% with a healing rate of 80%. Conclusion: RCW is an effective method in the treatment of diabetic neuropathic nonischemic foot ulceration. The healing rate of the ulceration by using this method of offloading mainly depends on the site of planter foot ulcer.

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