Casting of Recurrent Diabetic Foot Ulcers

A proof‐of‐concept study of the effectiveness of a removable device for offloading in patients with neuropathic ulceration of the foot: the Ransart boot

“…Nabuurs‐Franssen et al. [12] conducted an observational study of the use of both removable and irremovable casts in the management of 98 neuropathic ulcers, including those which were infected, ischaemic or both, and reported a similar overall rate of healing at 76%, but with a median time to healing of only 33 days. However, these authors found no difference between the effectiveness of removable and non‐removable casts.…”

“…They reported an overall median healing time of 63 days compared with 60 days in the present study and the eventual rate of healing was similar: 91.7 vs. 97.9%. Zimny and colleagues reported median times to healing of 77.5 and 75.9 days in two observational studies [21,23], while Nabuurs‐Franssen and colleagues [12] reported a median time to healing of just 18 days for non‐ischaemic, non‐infected neuropathic ulcers. There is no obvious explanation for the different times to healing of uncomplicated neuropathic ulcers in these various studies, ranging from 18 days in the Netherlands, to 28–35 days observed by Katz and colleagues, 45–47 days reported by Piaggesi et al.…”

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

“…Possible adverse effects of nonremovable offloading devices include muscle weakness, falls, new ulcers because of poor fitting, and knee or hip complaints because of the acquired limb‐length discrepancy when wearing the device . One may consider a shoe raise for the contralateral limb to minimize this acquired limb‐length discrepancy.…”

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

“…In a lowquality cohort study, healing proportions of neuropathic ulcers were 83% in a windowed TCC and 25% in two types of offloading shoes [18]. 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].…”