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Next Step Foot & Ankle Clinic

The "Gold Standard" of Diabetic Wound Care

“Hi, this is Dr. Silvester and I want to talk to you a little bit about what is considered the “gold standard” in taking care of diabetic foot ulcers. It’s interesting that it’s called that because almost nobody uses it. I just read an article in Lower Extremity Review, which discussed the use of the “gold standard”, and they staid that less than 10% of doctors use the “gold standard” in helping heal diabetic foot ulcers. So, what a gold standard is, for taking care of your diabetic foot ulcer, is called a total contact cast.

A total contact cast is a cast that you put on your foot and leg. Its purpose is to take pressure off the ulcer. As you are probably aware, if you have a diabetic foot ulcer, they almost always occur in areas where there is excessive pressure. By putting a cast on, you can eliminate that pressure and the healing process is allowed to occur.

The problem with that is that it’s a little inconvenient. That’s probably half the reason it works. People in a total contact cast don’t like to go for a walk, they don’t like to go to the store, they don’t like to get up when they don’t have to – it makes them stay down because their foot is in a heavy cast that takes pressure off the area and limits motion.

The cast also has some disadvantages in that it might make you sweat a little bit. Here in South Texas, it gets pretty hot, and the cast adds a lot to that. Another thing that can happen is you can get infections. That’s quite rare, but it can occur underneath the cast. Another thing that we’ve seen once in a while is a secondary ulcer. What I tell my patients is that the drawbacks of a total contact cast are not very significant when compared to the benefits of a total contact cast.

What I would say to you is if you have an ulcer and you haven’t been getting anywhere with your current treatment, a total contact cast makes good sense in trying to heal your diabetic foot ulcer. Thanks for listening.”