Which intervention provides the most effective offloading of pressure for a neuropathic plantar forefoot ulcer in a compliant outpatient diabetic patient?

• A Standard therapeutic footwear with molded insoles
• B Removable cast walker worn during all ambulation
• C Felted foam dressing with postoperative shoe
• D Total contact cast ✓

Explanation

The total contact cast redistributes plantar pressure over the entire foot, eliminates shear at the ulcer site, and enforces compliance because the patient cannot remove it, making it the gold standard offloading device and the fastest route to healing of neuropathic forefoot ulcers. Removable walkers offload well but patients frequently remove them and walk barefoot, losing much of their benefit. Footwear and felted foam reduce but do not abolish peak pressures under the metatarsal heads.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.