A diabetic patient presents with a painless plantar foot ulcer under the second metatarsal head classified as Wagner grade 2. The most critical initial intervention to promote healing is:

• A Systemic antibiotics alone
• B Immediate below-knee amputation
• C Split-thickness skin grafting over the ulcer bed
• D Total contact casting (TCC) or equivalent offloading of the ulcer ✓

Explanation

Wagner grade 2 is a deep ulcer penetrating to tendon, capsule, or bone without osteomyelitis. Offloading is the single most important intervention for neuropathic diabetic foot ulcers; total contact casting (TCC) redistributes plantar pressure across the entire foot surface, eliminating focal pressure at the ulcer site and allowing healing in 6–8 weeks in the majority of cases. Antibiotics are reserved for clinically infected ulcers; grade 2 without systemic infection signs does not mandate antibiotics. Amputation is reserved for non-salvageable limb-threatening infections. Skin grafting is inappropriate without adequate wound bed preparation and offloading.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.