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Use of Computed Tomography and Plantar Pressure Measurement for Management of Neuropathic Ulcers in Patients With Diabetes

MJ Mueller, PhD, PT, is Assistant Professor, Program of Physical Therapy, Washington University School of Medicine, Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (USA) (muellerm{at}medicine.wustl.edu).
KE Smith, AAS, is Engineer, Mallinckrodt Institute of Radiology, Washington University School of Medicine
PK Commean, BEE, is Engineer, Mallinckrodt Institute of Radiology, Washington University School of Medicine
DD Robertson, MD, PhD, is Assistant Professor, Mallinckrodt Institute of Radiology, Washington University School of Medicine
JE Johnson, MD, is Associate Professor, Department of Orthopaedic Surgery, Washington University School of Medicine

Address all correspondence to Dr Mueller

Background and Purpose. Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%–57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. Case Description. The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. Outcomes. The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. Discussion. Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.

Key Words: Computed tomography • Diabetes • Neuropathy • Pressure • Spiral x-ray • Ulcer

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