Comparison of Forefoot Ulcer Healing Using Alternative Off-loading Methods in Patients with Diabetes Mellitus

Abstract

The healing rate of forefoot ulcerations in patients with diabetes using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration.

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

“…The other evidence largely describes clinical outcomes from predominantly prospective and retrospective epidemiological studies of various offloading techniques [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Between 73% and 100% of wounds were reported to have healed in studies of TCCs, with healing times ranging between 30 and 63 days [23,29,39]. Fiberglass cast shoes were found to heal 91% of subjects in an average of 34 days [32].…”

“…Fiberglass cast shoes were found to heal 91% of subjects in an average of 34 days [32]. Studies of Scotch-cast boots, windowed casts, and custom splints have reported between 70% and 81% of subjects healed between 42 and 300 days [23,40,41].…”

“…The results of these studies were discussed in the previous sub-chapter. Within the limitations of their designs, the results from level 3 studies suggest that molded and ethylene vinyl acetate (EVA) boots can play a role in ulcer healing [42,43], that various types of shoes and offloading insoles can, under some circumstances, result in healing [44][45][46][47], and that half-shoes can be effective in the treatment of plantar ulcers [23,48,49].…”

“…The use of a walking brace (plantar healing orthosis) in a small CBA study of poor quality did not lead to higher healing proportions than topical ulcer care, but the study may have been underpowered [83]. In a retrospective analysis, accommodative dressing (felted foam) worn in a surgical shoe, a healing shoe, or a walking splint was found to be as effective as a TCC in both healing proportion and time to healing [23]. Finally, two case studies of patients with recalcitrant plantar ulceration showed that continued treatment with a Cam walker with plastazote arch filler [84] or an ankle-foot orthosis [85] resulted in healing within 4 months and 12 weeks, respectively.…”

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…There are also reports of good healing outcomes achieved with devices such as felt deflection and healing shoes. 109,110,115 Emerging reports support surgical offloading to prevent recurrence where foot deformity is the cause of ulceration, and other treatments to heal or prevent recurrence have failed. 116,117 This is reflected in the latest international guidelines from the IWGDF, which recommend surgical procedures to achieve pressure offloading.…”