Offloading diabetic foot wounds using the scotchcast boot: a retrospective study

A retrospective study was conducted to evaluate treatment outcomes associated with the treatment of diabetic foot ulcers using the Scotchcast boot. Data were extracted from the records of 180 patients with diabetes, 150 (83.3%) male, with a mean age of 55.3 +/- 10.9 years undergoing treatment for noninfected, non-ischemic neuropathic diabetic foot wounds at a university teaching hospital's tertiary care outpatient clinic. All patients who met the criteria were treated with the Scotchcast boot as the sole form of pressure relief. The average follow-up for each patient was 85.9 +/- 30.6 months (range 34.2 to 147.7 months). The mean time to healing for all patients was 130.5 +/- 106.7 days. Superficial (Grade 1) wounds healed significantly faster than deep (Grade 3) wounds (111.5 +/- 98.2 versus 180.8 +/- 138.8 days, P = 0.01) and 144 (80%) wounds healed during the follow-up period. Of the 36 (20%) that did not heal with Scotchcast boot therapy, 10 went on to more proximal amputation (5.6% of total population), two required surgical intervention to heal their wounds (0.6% of total population), one patient died with an unhealed wound (0.6% of total population), 23 patients (12.8% of total population) were lost to follow-up, and 47 (26%) died. Experience and the results of this and other studies suggest that this removable modality may be useful in outpatient care of deeper or complex wounds that require frequent inspection, but a device that ensures compliance may be the preferred treatment of superficial wounds.