Nonremovable, Windowed, Fiberglass Cast Boot in the Treatment of Diabetic Plantar Ulcers

Van, Georges Ha; Siney, H.; Hartmann-Heurtier, Agnes; Jacqueminet, S.; Greau, Françoise; Grimaldi, A

doi:10.2337/diacare.26.10.2848

Cited by 93 publications

(62 citation statements)

References 16 publications

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“…The percentages of healed ulcers in 12 weeks are comparable to percentages previously found for removable knee‐high prefabricated walkers, 52–79% , and for half shoes or other healing shoes, 43–70% . Time to healing in the cast shoe and FOS was comparable to what was found in previous studies testing similar type (cast) shoes: 60–70 days on average .…”

Section: Discussionsupporting

confidence: 82%

The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial

Bus

Netten

Kottink

et al. 2017

International Wound Journal

101

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Bus SA, van Netten JJ, Kottink AIR, Manning EA, Spraul M, Woittiez A-J, van Baal JG. The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single-blinded multicentre randomised controlled trial. Int Wound J 2018; 15:65-74 AbstractNon-removable offloading is the 'gold standard' treatment for neuropathic diabetic plantar forefoot ulcers. However, removable offloading is the common 'standard of care'. We compared three removable offloading devices for ulcer healing efficacy. In this multicentre, randomised controlled trial, 60 persons with neuropathic diabetic plantar forefoot ulcers were randomly assigned to wear a custom-made knee-high cast [BTCC (bivalved TCC)], custom-made ankle-high cast shoe or a prefabricated ankle-high forefoot-offloading shoe (FOS). Primary outcome was healing at 12 weeks. Dynamic plantar pressures, daily stride count and treatment adherence were assessed on a randomly selected subset (n = 35). According to intention-to-treat analysis, 58% of patients healed with BTCC [OR 0⋅77 (95% CI 0⋅41-1⋅45) versus FOS], 60% with cast shoe [OR 0⋅81 (95% CI 0⋅44-1⋅49) versus FOS] and 70% with FOS (P = 0⋅70). Mean ± SD peak pressure in kPa at the ulcer site was 81 ± 55 for BTCC, 176 ± 80 for cast shoe and 107 ± 52 for FOS (P = 0⋅005); stride count was 4150 ± 1626, 3514 ± 1380 and 4447 ± 3190, respectively (P = 0⋅71); percentage of 2-week intervals that patients wore the device <50% of time was 17⋅3%, 5⋅2% and 4⋅9%, respectively. Non-significant differences in healing efficacy between the three devices suggest that, when non-removable offloading is contraindicated or not available, each can be used for plantar forefoot ulcer offloading. Efficacy is lower than previously found for non-removable offloading maybe because suboptimal adherence and high stride count expose the patient to high repetitive stresses. These factors should be carefully considered in decision making regarding ulcer treatment.

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Section: Discussionsupporting

confidence: 82%

The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial

Bus

Netten

Kottink

et al. 2017

International Wound Journal

101

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“…In the study of Ha Van et al (25), the presence of a persistent ulcer prompted clinicians to provide patients with a TCC rather than an orthopedic cast walker boot, and patients treated with a TCC achieved better outcomes. It could be hypothesized that the “persistent ulcer” in the study of Ha Van et al might have played a role similar to that of the “previous ulcer” in our study.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Removable Walker Cast Versus Nonremovable Fiberglass Off-Bearing Cast in the Healing of Diabetic Plantar Foot Ulcer

Faglia

Caravaggi²,

Clerici

et al. 2010

Diabetes Care

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OBJECTIVETo evaluate the efficacy of a removable cast walker compared with that of a nonremovable fiberglass off-bearing cast in the treatment of diabetic plantar foot ulcer.RESEARCH DESIGN AND METHODSForty-five adult diabetic patients with nonischemic, noninfected neuropathic plantar ulcer were randomly assigned for treatment with a nonremovable fiberglass off-bearing cast (total contact cast [TCC] group) or walker cast (Stabil-D group). Treatment duration was 90 days. Percent reduction in ulcer surface area and total healing rates were evaluated after treatment.RESULTSA total of 48 patients were screened; however, 2 patients in the TCC group and 1 patient in the Stabil-D group did not complete the study and were considered dropouts. There were no significant differences in demographic and clinic characteristics of the 45 patients completing the study. Ulcer surface decreased from 1.41 to 0.21 cm2 (P < 0.001) in the TCC group and from 2.18 to 0.45 cm2 (P < 0.001) in the Stabil-D group, with no significant differences between groups (P = 0.722). Seventeen patients (73.9%) in the TCC group and 16 patients (72.7%) in the Stabil-D group achieved healing (P = 0.794). Average healing time was 35.3 ± 3.1 and 39.7 ± 4.2 days in the TCC and Stabil-D group, respectively (P = 0.708).CONCLUSIONSThe Stabil-D cast walker, although removable, was equivalent in efficacy to the TCC in terms of ulcer size reduction and total healing rate. The easier use of Stabil-D may help increase the use of off-loading devices in the management of plantar neuropathic diabetic foot ulcers.

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“…A Cochrane systematic review and meta‐analysis included five randomized controlled trials (RCTs) with a cumulative total of 230 patients and found a relative risk ratio of 1.17 [95% confidence interval (CI) 1.01–1.36, p = 0.04] for non‐removable offloading to achieve healing compared with removable offloading . Another systematic review and meta‐analysis included ten randomized and non‐randomized clinical studies with a cumulative total of 524 patients and showed a significantly higher relative risk ratio of 1.43 (95% CI 1.11–1.84, p = 0.001) for non‐removable offloading to achieve healing compared with removable offloading . Based on two relatively small RCTs , there is evidence to suggest that a removable walker rendered irremovable is as effective as a TCC in healing neuropathic plantar forefoot ulcers (Relative risk ratio = 1.06; 95% CI 0.88–1.27, p = 0.31) .…”

Section: Casting and Prefabricated Healing Devicesmentioning

confidence: 99%

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Bus

Armstrong

Deursen

et al. 2016

Diabetes Metabolism Res

176

196

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RecommendationsCasting and prefabricated healing devices 1. To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection in a patient with diabetes, offload with a non-removable knee-high device with an appropriate foot-device interface. (GRADE strength of recommendation: strong, Quality of evidence: high) 2. When a non-removable knee-high device is contraindicated or not tolerated by the patient, consider offloading with a removable knee-high walker with an appropriate foot-device interface to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the device. (Weak; Moderate) 3. When a knee-high device is contraindicated or cannot be tolerated by the patient, consider offloading with a forefoot offloading shoe, cast shoe, or custom-made temporary shoe to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the shoes. (Weak; Low) Therapeutic footwear4. To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) 5. Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent nonplantar ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles, or toe orthosis. (Strong; Low) 6. To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressurerelieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) 7. Do not prescribe, and instruct a patient with diabetes not to use, conventional or standard therapeutic shoes to heal a plantar foot ulcer. (Strong; Low) 8. Consider using shoe modifications, temporary footwear, toe spacers, or

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Nonremovable, Windowed, Fiberglass Cast Boot in the Treatment of Diabetic Plantar Ulcers

Abstract: A nonremovable fiberglass cast boot was effective in healing diabetic plantar ulcers and in decreasing the risk of secondary osteomyelitis. The cast boot forced compliance with off-loading, thus promoting healing.

Cited by 93 publications

References 16 publications

The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial

The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial

Effectiveness of Removable Walker Cast Versus Nonremovable Fiberglass Off-Bearing Cast in the Healing of Diabetic Plantar Foot Ulcer

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

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