Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 6 , ISSUE 1 ( January-June, 2019 ) > List of Articles

Original Article

A Description of a Modified Bohler Iron Walking Cast in the Management of Plantar Ulcers

Srikant Venkatakrishnan, Kurian Zachariah, Paulraj Chinnappan, Nidhi Rawat

Keywords : Articulated Bohler, Bohler iron, Hindfoot ulcer, Off-loading, Plantar ulcer

Citation Information : Venkatakrishnan S, Zachariah K, Chinnappan P, Rawat N. A Description of a Modified Bohler Iron Walking Cast in the Management of Plantar Ulcers. J Foot Ankle Surg Asia-Pacific 2019; 6 (1):10-12.

DOI: 10.5005/jp-journals-10040-1101

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: The aim of this study is to describe the method of Bohler iron plaster casting and a modification of the technique—the articulated Bohler iron walking cast. Background: Trophic ulcers are a common problem for clinicians managing foot disorders, especially with the increasing prevalence of diabetic foot disease. Management of trophic ulcers requires offloading. The gold standard of off-loading, total contact casting (TCC), has disadvantages which include incomplete offloading, variable expertise in the application, and lack of access for wound care. Bohler iron plaster casting is less commonly used and is efficacious in plantar ulcer management. A modified method of Bohler iron casting can be used to manage midfoot and hindfoot ulcers. Technique: Bohler iron plaster casting is done by attaching iron uprights with an elevated platform to a below-knee cast. A layer of casting material is applied over the uprights to secure the apparatus. A cut out is made at the site of the plantar wound to allow access for dressing. The disadvantage of the conventional method is that midfoot and hindfoot ulcers are less accessible for wound care. To facilitate hindfoot wound care, a joint with a drop lock mechanism is incorporated in the uprights. The hinge joint allows pivot of the uprights and drop lock allows for the stability of the apparatus during weight-bearing. Conclusion: Midfoot and hindfoot ulcers can be well managed with an articulated Bohler iron plaster cast. The method allows for off-loading of the ulcer, facilitating wound care and ambulation. Further studies are required to describe ulcer-healing efficacy and compare this technique with conventional offloading methods. Clinical significance: The described techniques can be useful tools in the management of plantar ulcers especially those involving the mid- and the hindfoot.


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