Emerging Insights On Ex-Fix Offloading For Diabetic Foot Ulcers

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Author(s): 
William P. Grant, DPM, FACFAS, Lisa M. Grant, and Bryan R. Barbato, BS

   In comparison, other studies utilizing TCC had averages of 43 days of therapy duration, a 90.3 percent healing rate, a 23.4 percent complication rate and a 32 percent ulcer recurrence rate.1-12

Final Notes

Offloading external fixation is a valuable and beneficial tool for the podiatrist to employ in limb salvage. Just as TCC has become a gold standard for less complex diabetic foot ulcers, the external fixator may in fact become acknowledged as a gold standard in complex diabetic wound repair.

   Dr. Grant is a Fellow of the American College of Foot and Ankle Surgeons, and is board-certified by the American Board of Podiatric Surgery. He is an instructor in the Department of Surgery at Eastern Virginia Medical School and is in private practice in Virginia Beach, Va.

   Ms. Grant is a third-year podiatric medical student at Des Moines Medical University.

   Mr. Barbato is a graduate of James Madison University and a current applicant to colleges of podiatric medicine.

References
1. Sinacore DR, Mueller MJ, Diamond JE, et al. Diabetic neuropathic ulcers treated by total contact casting: a clinical report. Phys Ther. 1987;67(10):1543-49.
2. Boulton AJ, Bowker JH, Gadia M, et al. Use of plaster casts in the management of diabetic neuropathic foot ulcerations: a case report. Phys Ther. 1987;67(10):1550-1552
3. Helm PA, Walker SC, Pullium G. Total contact casting in diabetic patients with neuropathic foot ulcerations. Arch Phys Med Rehabil. 1984;65(11):691-93.
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9. Diamond JE, Mueller MJ, Delitto A. Effects of total contact cast immobilization of subtalar and talocrural joint motion in patients with diabetes mellitus. Phys Ther. 1993;73(5):310-15.
10. Nawoczenski DA, Birke JA, Graham SL, Koziatek E. The neuropathic foot — a management scheme: a case report. Phys Ther. 1989;69(4):287-91.
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12. Baker RE. Total contact casting. J Am Podiatr Med Assoc. 1995:85(3):172-6.
13.  Armstrong DG, Lavery LA, Wu S, Boulton AJ. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care. 2005;28(3):551-554.
14. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21(5):855-859.
15. National Diabetes Data Group. Diabetes in America. Vol. 2. (NIH publ. no. 95-1468). National Institute of Health, Bethesda, MD, 1995.
16. Margolis DJ., Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: the association of wound size, wound duration and wound grade on healing. Diabetes Care. 2002;25(10):1835-39.
17. Grant WP, Laurence RG, Pupp GR, Vito G, Jacobus D, Jerlin EA, Tam HS. (2007, October). Mechanical testing of seven fixation methods for generation of compression across a midtarsal osteotomy: a comparison of internal and external fixation devices. J Foot Ankle Surg. 2007; 46(5):325-35.

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