Healing times of pedal ulcers in diabetic immunosuppressed patients after transplantation

Objective: To compare the healing time of neuropathic plantar ulcers treate d by total-contact casting (TCC) in diabetic, immunosuppressed patients aft er organ transplantation with the healing time of plantar ulcers in control nonimmunosuppressed patients. Design: A case-control design with the control group matched for age, race, sex, body dimensions (height, weight, and body mass index), presence of se nsory neuropathy, foot deformity presence and location, and pedal ulcer are a and depth. Setting: An outpatient physical therapy clinic in a regional tertiary-care hospital and academic medical center. Participants: Nine patients with chronic diabetes mellitus and a previous o rgan transplantation who were currently receiving lifelong immunosuppressiv e drug therapy were treated for a neuropathic plantar ulcer by means of TCC , Fourteen group-matched control subjects with diabetes mellitus and a plan tar ulcer but who had never had an organ transplantation and were not takin g immunosuppressive agents were also studied. Interventions: TCC with partial weight-bearing using an assistive device un til ulcers healed. Main Outcome Measure: Healing time was defined as the number of days in the total-contact cast until the skin completely closed. Results: All diabetic foot ulcers healed with casting. Immunosuppressed/tra nsplanted patients healed in a mean time of 111 +/- 25 days; ulcers of cont rol subjects healed in 47 +/- 18 days (p < .05). An patients returned to am bulation using prescribed therapeutic footwear, None of the patients requir ed a lower extremity amputation throughout the follow-up period. Conclusions: TCC is a highly effective and rapid method of healing neuropat hic pedal ulcers in diabetic immunosuppressed/transplantation patients, alt hough it may take several weeks longer than it would for patients who were not immunocompromised. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.