Effect of total contact cast immobilization on subtalar and talocrural joint motion in patients with diabetes mellitus

Background and Purpose. The purpose of this study was to determine the effect of total contact casting (TCC) on dorsiflexion at the talocrural joint (TCJ) and motion (inversion/eversion) at the subtalar joint (STJ). Subjects. Thirty-seven patients (29 men, 8 women), ranging in age from 32 to 79 years (X̄=54), SD=11), with diabetes mellitus and a unilateral plantar ulceration participated in the study. Methods. The subjects were measured with a goniometer for dorsiflexion and STJ range of motion (ROM). The ROMs for each subject's casted and noncasted legs were compared before and after treatment with TCC for neuropathic plantar ulcers by use of a 2x2 repeated-measures analysis of variance design. Results. Mean time of immobilization in TCC (healing time) was 42 days (SD=43, range=8-119). The results indicated (1) ROM was unchanged at the STJ, but dorsiflexion decreased slightly (1°) on both the casted and noncasted sides following the last cast removal, and (2) ROM was less on the ulcerated side prior to casting compared with the nonulcerated side. Conclusion and Discussion. We believe the beneficial effects (healing of wounds) outweigh the minimal detrimental effects (decreased dorsiflexion) of treatment with TCC.