Offloading–An Effective Treatment in the Healing of Diabetic Foot Lesions.

ABSTRACT

Background: To compare the effectiveness of Total contact casts (TCCs), Removable cast walkers (RCWs) and half-shoes to heal diabetic foot lesions. Methods: This proposed study was carried out as a prospective, randomized clinical trial in 100 patients diagnosed diabetic foot with superficial non-infected, non-ischemic diabetic plantar foot ulcers. Out of 100 pts, 10 pts did not use any prosthesis and in 90 pts, one of the three offloading modalities was used Total contact cast (TCC), Removable cast walker (RCW) and half shoes (HS). Outcomes were assessed at wound healing or at 12 weeks, whichever came first. Primary outcome measures included duration of healing of diabetic wounds and also regarding the percent of wounds healed completely after 12 weeks. Results: The proportions of healing for patients treated with TCC, RCW, and HS were 85.7, 68.7, and 56.2%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities. There was also a significant difference in survival distribution (time to healing) between patients treated with a TCC and both an RCW and half-shoe. The mean number of days to complete wound healing is 30 days for TCC, 52 days for RCW and 60 days for HS. Conclusion: The TCC seems to heal a higher proportion of wounds in a shorter amount of time than two other widely used off-loading modalities, the RCW and the half-shoe.