title: A comparative study between total contact cast and pressure-relieving ankle foot orthosis in diabetic neuropathic foot ulcers.
abstract: Off-loading of the ulcer area is extremely important for the healing of plantar ulcers. Off-loading with total contact cast (TCC) may be superior to other off-loading strategies studied so far, but practical limitations can dissuade clinicians from using this modality. This study was conducted to evaluate the efficacy of TCC compared with that of a pressure-relieving ankle foot orthosis (PRAFO) in healing of diabetic neuropathic foot ulcers and their effect on gait parameters. Thirty adult diabetic patients attending the foot clinic with neuropathic plantar ulcers irrespective of sex, age, duration and type of diabetes were randomly assigned to 1 of 2 off-loading modalities (TCC and PRAFO). Main outcome measures were ulcer healing after 4 weeks of randomization and effect of each of the modalities on various gait parameters. The percentage reduction of the ulcer surface area at 4 weeks from baseline was 75.75 ± 9.25 with TCC and 34.72 ± 13.07 with PRAFO, which was significantly different (P < .001). The results of this study however, showed that most of the gait parameters were better with PRAFO than with TCC. This study comprehensively evaluated the well known advantages and disadvantages of a removable (PRAFO) and a nonremovable device (TCC) in the treatment of diabetic neuropathic foot ulcer. Further studies are needed involving larger subjects and using 3D gait analysis to collect more accurate data on gait parameters and wound healing with different off-loading devices.
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Partha Pratim
authors.initials: PP
authors.lastname: Chakraborty
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India sayantan.ray30@gmail.com.
authors.forename: Sayantan
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Dibakar
authors.initials: D
authors.lastname: Biswas
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Arjun
authors.initials: A
authors.lastname: Baidya
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Rana
authors.initials: R
authors.lastname: Bhattacharjee
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Pradip
authors.initials: P
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India.
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
mesh_terms: D002370:Casts, Surgical; D017719:Diabetic Foot / Q000628:therapy*; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D061826:Foot Orthoses; D016523:Foot Ulcer / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: PRAFO; TCC; diabetes; foot ulcer; neuropathy; off-loading