A Comparative Study Between Total Contact Cast and Pressure-relieving Ankle Foot Orthosis in Diabetic Neuropathic Foot Ulcers

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2014 Dec 3

PMID 25452635

Citations 10

Authors

Partha Pratim Chakraborty

Sayantan Ray

Dibakar Biswas

Arjun Baidya

Rana Bhattacharjee

Pradip Mukhopadhyay

Sujoy Ghosh

Satinath Mukhopadhyay

Subhankar Chowdhury

Affiliations

Soon will be listed here.

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.

Citing Articles

Comparison of In-Shoe Pedobarographic Variables between 2 Orthoses during Toe and Heel Gaits.

Kyung M, Seo H, Yoon Y, Kim D, Lee S, Lee D Clin Orthop Surg. 2024; 16(6):987-993.

PMID: 39618532 PMC: 11604570. DOI: 10.4055/cios24106.

Genetic Characterization of Methicillin-Resistant Staphylococcus aureus Isolated From Diabetic Foot Ulcers in a Tertiary Care Hospital in Mysuru, South India.

Gs V, Sumana M, Maheshwarappa Y, Mahale R, Shylaja C, Karthik K Cureus. 2024; 16(10):e70605.

PMID: 39483566 PMC: 11525841. DOI: 10.7759/cureus.70605.

Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome.

Gauna C, Romeo F, Scatena A, Miranda C, Uccioli L, Vermigli C Acta Diabetol. 2024; 61(6):693-703.

PMID: 38489054 DOI: 10.1007/s00592-024-02262-9.

Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic.

Huynh T, Pilkey B, Trepman E, Dascal M, Dascal R, Embil J Can J Surg. 2023; 66(5):E513-E519.

PMID: 37875304 PMC: 10609890. DOI: 10.1503/cjs.006022.

Ventral Windowed Total Contact Casts Safely Offload Diabetic Feet and Allow Access to the Foot.

Hochlenert D, Fischer C J Diabetes Sci Technol. 2020; 16(1):137-143.

PMID: 33095036 PMC: 8875042. DOI: 10.1177/1932296820964069.

References

Dang C, Boulton A . Changing perspectives in diabetic foot ulcer management. Int J Low Extrem Wounds. 2005; 2(1):4-12. DOI: 10.1177/1534734603002001002. View

Boulton A . The pathogenesis of diabetic foot problems: an overview. Diabet Med. 1996; 13 Suppl 1:S12-6. View

Pham H, Armstrong D, Harvey C, Harkless L, Giurini J, Veves A . Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000; 23(5):606-11. DOI: 10.2337/diacare.23.5.606. View

McGuire J . Transitional off-loading: an evidence-based approach to pressure redistribution in the diabetic foot. Adv Skin Wound Care. 2010; 23(4):175-88. DOI: 10.1097/01.ASW.0000363528.16125.a7. View

Kumar S, Ashe H, Parnell L, Fernando D, Tsigos C, Young R . The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med. 1994; 11(5):480-4. DOI: 10.1111/j.1464-5491.1994.tb00310.x. View

Frykberg R, Lavery L, Pham H, Harvey C, Harkless L, Veves A . Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care. 1998; 21(10):1714-9. DOI: 10.2337/diacare.21.10.1714. View

Armstrong D, Lavery L, Kimbriel H, Nixon B, Boulton A . Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. Diabetes Care. 2003; 26(9):2595-7. DOI: 10.2337/diacare.26.9.2595. View

Lavery L, Armstrong D, Walker S . Healing rates of diabetic foot ulcers associated with midfoot fracture due to Charcot's arthropathy. Diabet Med. 1997; 14(1):46-9. DOI: 10.1002/(SICI)1096-9136(199701)14:1<46::AID-DIA291>3.0.CO;2-T. View

Abbott C, Carrington A, ASHE H, Bath S, Every L, Griffiths J . The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002; 19(5):377-84. DOI: 10.1046/j.1464-5491.2002.00698.x. View

10.

Singh N, Armstrong D, Lipsky B . Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293(2):217-28. DOI: 10.1001/jama.293.2.217. View

11.

Ganguly S, Chakraborty K, Mandal P, Ballav A, Choudhury S, Bagchi S . A comparative study between total contact casting and conventional dressings in the non-surgical management of diabetic plantar foot ulcers. J Indian Med Assoc. 2008; 106(4):237-9, 244. View

12.

Icks A, Haastert B, Trautner C, Giani G, Glaeske G, Hoffmann F . Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. findings from nationwide insurance data, Germany, 2005-2007. Exp Clin Endocrinol Diabetes. 2009; 117(9):500-4. DOI: 10.1055/s-0029-1225333. View

13.

Grewal G, Bharara M, Menzies R, Talal T, Armstrong D, Najafi B . Diabetic peripheral neuropathy and gait: does footwear modify this association?. J Diabetes Sci Technol. 2013; 7(5):1138-46. PMC: 3876356. DOI: 10.1177/193229681300700506. View

14.

Faglia E, Caravaggi C, Clerici G, Sganzaroli A, Curci V, Vailati W . Effectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer: a randomized controlled trial. Diabetes Care. 2010; 33(7):1419-23. PMC: 2890332. DOI: 10.2337/dc09-1708. View

15.

Moxey P, Gogalniceanu P, Hinchliffe R, Loftus I, Jones K, Thompson M . Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011; 28(10):1144-53. DOI: 10.1111/j.1464-5491.2011.03279.x. View

16.

Young M, Boulton A, Macleod A, Williams D, Sonksen P . A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993; 36(2):150-4. DOI: 10.1007/BF00400697. View

17.

Lebrun E, Tomic-Canic M, Kirsner R . The role of surgical debridement in healing of diabetic foot ulcers. Wound Repair Regen. 2010; 18(5):433-8. DOI: 10.1111/j.1524-475X.2010.00619.x. View

18.

Stess R, Jensen S, Mirmiran R . The role of dynamic plantar pressures in diabetic foot ulcers. Diabetes Care. 1997; 20(5):855-8. DOI: 10.2337/diacare.20.5.855. View

19.

Lauterbach S, Kostev K, Kohlmann T . Prevalence of diabetic foot syndrome and its risk factors in the UK. J Wound Care. 2010; 19(8):333-7. DOI: 10.12968/jowc.2010.19.8.77711. View

20.

Wu S, Crews R, Armstrong D . The pivotal role of offloading in the management of neuropathic foot ulceration. Curr Diab Rep. 2005; 5(6):423-9. DOI: 10.1007/s11892-005-0049-5. View