Removable Casts Effective in Treating Diabetic Foot Ulcers

Diabetic plantar ulcers heal just as well with removable walker casts as with nonremovable fiberglass total-contact casts, according to a new study.

Researchers at Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica (Milan, Italy) randomized 48 patients with nonischemic, noninfected neuropathic plantar ulcer to either a removable walker cast (Stabil-D) or a nonremovable fiberglass total contact cast (the control group). Two patients in the control group and one in the Stabil-D group did not complete the study, leaving 45 for the final analysis. The researchers found that 17 controls and 16 Stabil-D subjects achieved ulcer healing; average healing times were similar in both groups; 35.3 days in the control group and 39.7 days in the Stabil-D group. The researchers reported that among the 23 patients in the control group, average ulcer surface area shrank from 1.41 cm² at baseline to 0.21 cm² after treatment; in the 22 Stabil-D group patients, mean ulcer area shrank from 2.18 cm² at baseline to 0.45 cm², indicating that there was no difference between the two groups in ulcer surface area change.

The researchers concluded that the removable cast could be a good option when patients cannot receive a nonremovable total-contact cast; such patients include those with infection or critical ischemia, those who are very elderly or have problems with vision or equilibrium, and those with a contralateral foot ulcer or varicose veins. The researchers also cautioned that in any case, the deciding factor in recovery could be the patient's likely compliance with a removable cast. The study was published online ahead of print on March 31, 2010, in Diabetes Care.

"I would suggest a removable walker for patients with high compliance and a total contact cast or nonremovable walker for patients with poor compliance,” said lead author Giacomo Clerici, M.D. "Because this study is a noninferiority trial... we cannot say that the use of a removable walker should be the treatment of choice for patients with neuropathic ulcers.”

The Stabil-D walker used in the study is a specifically designed rigid, boat shaped, and fully rocker bottom sole, made by Podartis (Montebelluna, Italy).

Related Links:
Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica
Podartis