Which intervention is considered the gold standard for offloading a neuropathic plantar forefoot ulcer in a compliant, ambulatory diabetic patient without infection or critical ischaemia?

• A Standard therapeutic footwear with moulded insoles
• B Total contact cast ✓
• C Strict bed rest until epithelialisation
• D Felted foam dressing with postoperative shoe

Explanation

The total contact cast redistributes pressure over the whole sole, eliminates shear at the ulcer site during gait, and enforces compliance because the patient cannot remove it. It achieves the highest healing rates for uncomplicated neuropathic plantar ulcers compared with removable walkers and felted foam. Bed rest heals ulcers but is impractical and deconditioning. Removable devices fail whenever patients wear them less than prescribed, which is the commonest reason offloading fails outside a cast.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.