Offloading of Diabetic Neuropathic Plantar Ulcers: Secondary Analysis of Step Activity and Ulcer Healing.
Deborah M Wendland, Paul W Kline, Kathryn L Bohnert and 2 others
PMID 36940375WHAT IT FOUND
Patients in nonremovable total contact casts healed 93% of diabetic foot ulcers in an average of 77 days.
Those in removable walkers healed 65% in 138 days and took more steps, suggesting the cast's forced adherence and step restriction drive faster healing.
Key findings
01The total contact cast group had a significantly higher healing rate (93%) compared to the removable cast walker group (65%).
02Among those who healed, the average time to healing was significantly shorter for the total contact cast group (77 days) than for the removable cast walker group (138 days).
03Patients in the removable cast walker group had a greater average daily step count (2,597 steps) than those in the total contact cast group (1,813 steps), though this difference was not statistically significant.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The study included a significant number of nonrandomized participants (24% of the TCC group and 23% of the RCW group) who chose their treatment based on preference, which introduces selection bias. Participants in the RCW group could remove both the walker and the activity monitor, potentially leading to an underestimation of step activity if they walked without the device. The study did not control for other factors that influence healing, such as exact adherence to weight-bearing restrictions or offloading device removal times. The sample size was relatively small (55 participants), which may limit the generalizability of the step activity findings.
Declared interests
The authors declared no conflicts of interest. The study was conducted at Washington University School of Medicine.
The easy way to misread this
Do not assume the removable cast walker is equally effective if the patient simply wears it. The TCC's advantage lies in forced adherence and the inability to remove it, which naturally restricts sustained walking intensity. An RCW requires strict behavioral compliance to match TCC outcomes.