Use of computed tomography and planter pressure measurement for managementof neuropathic ulcers in patients with diabetes

Background and Purpose. Total contact casting is effective at healing neuro pathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from planter pressure measurement and spiral x-ra y computed tomography (SXCT) were used to help manage a patient with recurr ent plantar ulcers and to discuss potential future benefits of this technol ogy. Case Description. The patient was a 62-year-old man with type 1 diabetes me llitus (DM) of 33 years' duration, peripheral neuropathy and a recurrent pl antar ulcer. Although total contact casting or relieving weight bearing wit h crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous p ressure measurement were conducted to better understand the mechanism of hi s ulceration. Outcomes. The patient had a severe bony deformity that coincided with the l ocation of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing anti walking for 8 to 10 hours a day. Discussion. Following intervention, the patient's recurrent ulcer healed an d remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and Fabricate optimal or tho ses. [Mueller MJ, Smith KE, Commean PK et al. Use of computed tomography an d plantar pressure measurement for management of neuropathic ulcers in pati ents with diabetes. Phys Ther. 1999; 79:296-307.].