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Off-loading the diabetic foot wound: a randomized clinical trial.
D G Armstrong1, H C Nguyen, L A Lavery
1Audie L. Murphy Veterans Affairs Medical Center, Tucson, AZ 85723, USA. armstrong@usa.net
Diabetes Care
|May 26, 2001
Summary
Total-contact casts (TCCs) heal diabetic foot ulcers more effectively than removable cast walkers (RCWs) or half-shoes. TCCs promote faster healing, though they reduce patient activity levels compared to half-shoes.
Area of Science:
- Diabetic foot ulcer management
- Podiatric medicine
- Wound healing research
Background:
- Diabetic foot ulcers are a significant cause of morbidity.
- Effective off-loading is crucial for healing neuropathic foot ulcerations.
- Various off-loading devices exist, including total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes.
Purpose of the Study:
- To compare the healing effectiveness of TCCs, RCWs, and half-shoes.
- To evaluate the impact of these off-loading modalities on patient activity levels.
- To determine the optimal off-loading strategy for diabetic foot ulcers.
Main Methods:
- Prospective clinical trial involving 63 diabetic patients.
- Randomization to TCC, half-shoe, or RCW off-loading.
- Assessment of wound healing at 12 weeks and daily activity (steps per day).
Main Results:
- Total-contact casts (TCCs) achieved an 89.5% healing rate, significantly higher than RCWs (65.0%) and half-shoes (58.3%).
- TCCs demonstrated a significantly shorter time to healing compared to both RCWs and half-shoes.
- Patients in TCCs were significantly less active (600 steps/day) than those in half-shoes (1,461 steps/day).
Conclusions:
- Total-contact casts (TCCs) are superior for healing diabetic neuropathic foot ulcers.
- TCCs heal a higher proportion of wounds in a shorter time compared to RCWs and half-shoes.
- While effective, TCCs may reduce patient ambulation compared to other modalities.