Outpatient Treatment of Unilateral Diabetic Foot Ulcers with ‘Half Shoes’

Abstract

The impact of 'half shoes' in the treatment of neuropathic forefoot ulcers was studied in two groups of diabetic patients, who were treated either by standard treatment alone (retrospective controls, n = 22), or by standard treatment plus 'half shoes' (cases, n = 26). The groups were matched for sex, age, type, and duration of diabetes and ulcer grading. The 'half-shoe' cases' vs controls' median overall healing time was 70 vs 118 days, the median difference being 48 (95% CI: -5 to 82) days (NS). In the case group, hospitalization was required in 1/26 (4%) of patients, vs 9/22 (41%) of the control patients (chi-square, p < 0.01). The home nursing service was required in 23% of the cases vs 18% of the controls (NS). It is concluded that the use of half-shoes, in conjunction with standard treatment provided by a specialized diabetic foot clinic, may reduce the overall healing time and does reduce the hospitalization rate. This has implications for a rational strategy of treating unilateral diabetic neuropathic foot ulcers.

Wound Microbiology and Associated Approaches to Wound Management

“…While there is a paucity of comparative trials evaluating these devices in a randomized fashion, a guide to the results of various reports is given in Table 5. While one cannot draw sharp conclusions from these reports (primarily due to significant differences in methods and populations), the consistency in the duration to healing with the total-contact cast has led to its being considered the "gold standard" in terms of its quality of off-loading (131) and duration to healing (3,7,51,103,104,108,129,167,171,220,241).…”

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

“…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].…”

Therapeutic footwear for people with diabetes

“…Shoes with no loadbearing surface under the forefoot have been shown to be effective in healing plantar ulcers in 70 days [13], and various forms of braces or walkers are also in use [14]. The TCC, as originally proposed by the Carville group, [12] may completely unload the ulcer site since soft foam placed over the wound forms a cavity in the cast.…”