Removable cast walker boots yield greater forefoot off-loading than total contact casts

Area of Science:

• Podiatry
• Diabetic Foot Care
• Biomechanics

Background:

• Elevated plantar loading is a key factor in diabetic foot ulcer development.
• Total contact casts and cast walker boots are standard treatments for off-loading.
• Comparing the efficacy of these off-loading devices is crucial for optimizing treatment.

Purpose of the Study:

• To compare the plantar loading reduction capabilities of total contact casts versus removable cast walker boots.
• To assess the effectiveness of these devices in managing diabetic foot ulcers.

Main Methods:

• Randomized trial involving 23 individuals with diabetes, neuropathy, and plantar ulcers.
• Plantar loading was measured barefoot and while using either a total contact cast or a cast walker boot.
• Analysis of covariance adjusted for walking speed and barefoot loading.

Main Results:

• No significant difference in overall foot off-loading between the two devices.
• Cast walker boots demonstrated greater reductions in forefoot peak pressure and force parameters.
• Ulcer healing times were similar, but a higher proportion of ulcers healed with total contact casting.

Conclusions:

• Cast walker boots provide better forefoot load reduction, targeting common diabetic ulcer sites.
• Despite superior off-loading, cast walker boots were associated with lower ulcer healing proportions.
• Patient compliance may play a significant role in the observed differences in ulcer healing efficacy.