hen diabetics suffering from serious foot ulcers first come to see Susan K. Bonar, MD, most are scared, concerned they might lose a foot to this difficult disease.

"They've either heard of a diabetic or known one who has had a foot amputated," said the director of the Foot and Ankle Center at Rockhill Orthopaedics. "But because of improved antibiotics and our success in healing ulcers with casts, few diabetics have this happen--and it's only done when the diabetic's life is at risk because of deep infection in the foot. Now we routinely save feet we used to lose."

An orthopedic surgeon, Dr. Bonar is one of a handful of medical specialists in the Kansas City area using total contact casts to treat diabetic ulcers of the feet. The procedure involves encasing the affected foot in a fully enclosed plaster cast for two weeks. The cast is padded extremely well to protect the foot. Because it is a walking cast, the diabetic can be mobile.

"For reasons we don't fully understand, enclosing the foot and toes in the cast usually promotes healing," Dr. Bonar said. "Many people are healed at the end of the two weeks when we take the cast off. Some require another two, or even four, weeks in a cast.

"In very difficult cases where the ulcer still hasn't healed after that time, we move on to other treatments. Sometimes we can remove a piece of bone in the foot and drain the ulcer that way. With proper foot inserts they can still walk well afterwards.

"Amputation becomes necessary only when ulceration cannot be healed and a diabetic's life is threatened. We literally cut off the problem. But I want to emphasize that we're having considerable success with casting."

Dr. Bonar and the staff at the Foot and Ankle Center are developing a strong reputation in the Kansas City area for treatment of foot problems related to diabetes. The casting technique they use was developed over 20 years ago by an orthopedist who worked with victims of leprosy in India and was looking for a way to treat their foot ulcers, which are similar to those suffered by many diabetics.

According to Dr. Bonar, "All diabetics are susceptible to foot problems, but not all get them. Diabetics who take good care of their health and monitor their disease carefully have fewer problems--but they may not be able to control the progress of the disease. I try to reassure people that when things go wrong, it's not their fault."

Dr. Bonar considers the treatment she provides to be only part of her job. "We also educate our patients on how to care for their feet. And if it finally comes down to having to have a foot amputated, we put them in touch with someone else who has had this done. Prostheses are very good these days, and what they learn is that losing a foot doesn't have to be the end of the world."

        ("On Track", Spring 1997)