Nonremovable, windowed, fiberglass cast boot in the treatment of diabetic plantar ulcers: Efficacy, safety, and compliance

• Published in: Diabetes care Vol. 26; no. 10; pp. 2848 - 2852
• Main Authors: HA VAN, Georges, SINEY, Hubert, HARTMANN-HEURTIER, Agnes, JACQUEMINET, Sophie, GREAU, Francoise, GRIMALDI, André
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.10.2003
• Subjects: Aged; Associated diseases and complications; Biological and medical sciences; Care and treatment; Casts, Surgical - adverse effects; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Foot - therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Foot; Humans; Male; Medical sciences; Middle Aged; Osteomyelitis - prevention & control; Patient Compliance; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Shoes; Technology. Biomaterials. Equipments. Material. Instrumentation; Ulcers; Weight-Bearing; Wound Healing; France; Endocrinopathy; Human; Nervous system diseases; Compliance; Toxicity; Diabetes mellitus; Treatment efficiency; Diseases of the osteoarticular system; Instrumentation; Bone disease; Neuropathy; Foot sole; Osteitis; Ulcer; Safety; Cicatrization; Mal perforans; Comparative study
• ISSN: 0149-5992
• DOI: 10.2337/diacare.26.10.2848

To compare the efficacy, safety, and compliance of a nonremovable fiberglass cast boot and off-loading shoes in the treatment of diabetic plantar ulcers. Patients (n = 93) with noninfected, nonischemic plantar ulcers were included in this prospective nonrandomized study. Treatment used a nonremovable fiberglass cast boot for longer standing and deeper ulcers (n = 42) and a half shoe or heel-relief shoe for other ulcers (n = 51). We evaluated off-loading therapy, compliance, and complications in both groups. The healing rate was significantly higher with the cast boot than with the off-loading shoe (81 vs. 70%, P = 0.017), with healing times of 68.6 +/- 35.1 vs. 134.2 +/- 133.0 days, respectively, and hazard ratio 1.68 (95% CI 1.04-2.70); complete compliance with treatment was 98 vs. 10% (P = 0.001), respectively. Secondary osteomyelitis developed in 3 patients in the cast boot group and 13 patients in the off-loading shoe group (P = 0.026). 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.