2005 Symposium on Advanced Wound Care | |
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Case Study
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Contact casting and the management of neuropathic ulcers John G. Martinez, MD; Paula Barkett, APRN, BC, CWOCN, Patricia Allen, RN, VA Southern Nevada Healthcare System, Las Vegas, NV Management of neuropathic ulcers is an important and challenging area of wound care practice. The Centers for Disease Control and Prevention estimate that approximately 15 percent of individuals with diabetes will develop foot ulcers, and 15 to 20 percent of those ulcers are estimated to result in lower extremity amputations. It is estimated that the cost of care associated with amputation ranges from $40,000 to $75,000 and there is a significant quality of life cost associated with these ulcers. There are many factors involved in the rate of healing neuropathic ulcers; one significant factor is the amount of foot offloading that can be accomplished. With all other factors managed optimally it is still unlikely that a neuropathic ulcer can be healed and kept healed without offloading the individual’s foot. We addressed this offloading problem by implementing a contact-casting program within our wound clinic. We purchased a unit dose type of contact casting kit and changed the casts weekly until the ulcer was healed. We transitioned the individuals with healed neuropathic ulcers to their permanent offloading footwear. Wound healing time was reduced in this group of patients following the implementation of the contact-casting program. References Centers for Disease Control. Diabetes surveillance: nontraumatic lower extremity amputation with diabetes. 2004. Available at: http://www.cdc.gov/diabetes/statistics/lea/fig7.htm. VHA directive 2001-030. Preservation-amputation care and treatment (PACT) program. Washington, DC.: Department of Veterans Affairs, Veterans Health Administration, 2001. Levin ME, O’Neal LW, Bowker JH. The Diabetic Foot, 5th ed. St. Louis, MO.: Mosby-Year Book, Inc., 1993. |
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