title: Effectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer: a randomized controlled trial.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Forty-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.
  
  
  RESULTS
  A 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 cm(2) (P < 0.001) in the TCC group and from 2.18 to 0.45 cm(2) (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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Diabetic Foot Center, Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Faglia
authors.forename: Carlo
authors.initials: C
authors.lastname: Caravaggi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Clerici
authors.forename: Adriana
authors.initials: A
authors.lastname: Sganzaroli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Curci
authors.forename: Wanda
authors.initials: W
authors.lastname: Vailati
authors.forename: Daniele
authors.initials: D
authors.lastname: Simonetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Sommalvico
mesh_terms: D000368:Aged; D002370:Casts, Surgical / Q000191:economics; D017719:Diabetic Foot / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices / Q000191:economics; D011312:Pressure; D012775:Shoes / Q000191:economics; D016896:Treatment Outcome; D016474:Weight-Bearing; D014945:Wound Healing