Plaster casts in the management of advanced ischaemic and neuropathic diabetic foot lesions.

The outcome of plaster cast treatment of diabetic ulcerations at different sites of the feet in 33 patients was assessed in a prospective study. They were selected for the study because the previous conservative treatment had been unsuccessful. The mean age was 68 years and Type 1/Type 2 ratio was 4/29. Fifteen patients had lesions of grade 2 severity according to Wagner's classification, 9 patients' lesions were grade 3, and 9 patients had grade 4 lesions. The lesions healed in 19 patients (58%). All 10 patients (100%) with plantar lesions healed, while 7 (44%) of the patients with ischaemic lesions on the toes underwent lower leg amputation (p less than 0.01). Other factors that were important in determining which patients underwent amputation included the presence of local pain (p less than 0.001), and ankle/arm pressure index (less than 0.5 vs greater than or equal to 0.5, p less than 0.001). We conclude that plaster cast treatment is more useful in the treatment of advanced foot lesions than has previously been reported.