Effectiveness of Total Contact Casting in the Treatment of Neuropathic Plantar Ulcers: An Observational Study

Introduction: Neuropathic ulcers occur mainly at the plantar aspect and correspond to areas with peak plantar pressure, usually seen in a sensory-deficient foot. Trophic ulcers are seen in diabetic neuropathy, post-leprosy, and any other neurological disorders that lead to peripheral sensory loss and ultimately lead to amputation. The treatment principle involves avoiding pressure on the ulcerated site, called 'offloading.' Conventional total contact casting (TCC) is an essential offloading modality for noninfected, non-ischemic neuropathic plantar ulcers. There is a paucity of literature showing the role of TCC in neuropathic foot ulcers. The present study aimed to evaluate the effectiveness of TCC in the treatment of neuropathic plantar ulcers. Materials and methods: After obtaining ethical clearance, the study was conducted at the Physical Medicine and Rehabilitation Department of a tertiary care center in West Bengal, India, from March 2024 to August 2024. Total contact casting was performed on 16 patients with neuropathic plantar ulcers. Assessment was performed at the first visit (zero weeks) and at the second, fourth, and sixth weeks. Results: Two-way repeated measures ANOVA was performed. The test revealed a statistically significant difference in ulcer volume between pre- and post-treatment (F = 7.742, p = 0.01). Bonferroni’s test for multiple comparisons found a statistically significant difference in the volumes of ulcers at the first and second follow-up from before the start of treatment. Upon applying split-plot repeated-measures ANOVA, no significant difference was found between the decrease in ulcer volume and the individual’s sex (F=.099, p=0.757). Conclusions: Total contact casting is an effective, non-invasive method for off-loading a plantar ulcer, though it is time-consuming and associated with minimal complications.