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Clinical Trial
. 2005 Mar;28(3):551-4.
doi: 10.2337/diacare.28.3.551.

Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial

David G Armstrong  1 , Lawrence A Lavery, Stephanie Wu, Andrew J M Boulton
Affiliations
Clinical Trial

Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial

David G Armstrong et al. Diabetes Care. 2005 Mar.

Abstract

Objective: The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.

Research design and methods: We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.

Results: An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1-2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 +/- 18.7 vs. 58.0 +/- 15.2 days, P = 0.02).

Conclusions: Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.

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