A randomised trial to study the efficacy of two offloading devices in the management of plantar diabetic foot ulcers

Sheetal, Sasidharan (2014) A randomised trial to study the efficacy of two offloading devices in the management of plantar diabetic foot ulcers. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Diabetes related peripheral neuropathy is a major etiological factor in the development of neuropathic foot ulcers. Repeated trauma and pressure on the ulcer bed are the two main reasons for persistence of ulcer. Offloading allows for pressure relief at areas of high pressure thus facilitating healing process of foot ulcers. It is suggested that “Pressure relief on ulcers commonly referred to as offloading should always be a part of the treatment plan” Cavanagh et al (2005). AIMS AND OBJECTIVES: The objective of this study is to compare the effectiveness of removable (custom made shoes) and irremovable (total contact cast) devices to offload plantar diabetic ulcers. The following aspects of offloading are looked upon: 1. wound surface areas reduction, 2. number and severity of adverse events. MATERIALS AND METHODS: Diabetic foot ulcer patients who have been admitted or have visited PSG hospital on OP basis were included in the study. 32 of these patients, who met inclusion and exclusion criteria of the study, formed the study population. After a detailed history, examination and necessary investigations, ulcers were surgically debrided to remove non viable tissues. Ulcers were photographed and measured and offloading devices were applied. Patients were advised 2 weekly follow-up for the next 3 months. The outcome was studied based on ulcer size reduction and the presence or absence of adverse events. RESULTS: A total of 32 patients were included in the study. Two patients in the TCC group and one patient in the custom made shoe group failed to complete the study. The ulcer surface area decreased from 6.82 cm2 - 1.34cm2 in TCC group and from 5.86 cm2 - 2.23 cm2 in custom made shoe group. Higher proportions of patients were healed by 12weeks in TCC group when compared to custom made shoe group. (1.34cm2, P value = 0.0154, Vs 2.23cm2, P value = 0.0016). Eleven out of the sixteen patients (68.7%) in TCC group had achieved complete healing with 90 days of treatment, of which 5 patients healed between 42 to 70 days and three out of the thirteen patients (23%) had attained complete healing in custom made shoe group at the end of 12 weeks. The mean number of days for the ulcer to heal in the TCC group was 66.63 days whereas in the custom made shoe group it was 83.23 days which infers that the mean duration of healing time was less with TCC than with custom made shoes. CONCLUSION: TCCs are gold standard in offloading diabetic foot ulcers with high proportion of healing rates in lesser amount of time compared to custom made shoes.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diabetes melliteus ; neuropathy ; plantar ulcers ; off-loading ; Total contact Cast.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jul 2018 03:02
Last Modified: 07 Jul 2018 03:02
URI: http://repository-tnmgrmu.ac.in/id/eprint/8694

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