Khalifa et al. 2023
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Khalifa WA, Argoon SA, AbdEllah-Alawi MH. Determinants of healing of diabetic foot ulcer comparing two offloading modalities: A randomized prospective study. Foot (Edinb). 2023 Mar 17;56:102016.
Design: Randomised Control Trial Subjects: 87 patients with active diabetic foot ulcers Methods: Participants were randomly assigned to either a removable walker (W-arm) or a cast-shoe (C-arm) at 3:2 ratio. Both groups received the routine ulcer care and were followed-up for 24 weeks. Outcomes included: SINBAD score, Adherence, Ulcer healing, Ulcer area and adverse events. Results: • The 24-week healing rate was 81% for the walker group and 62 % for the cast-shoe group. • The mean adherence was 55 % ± 26 % and 46 % ± 29 for the walker and cast shoe groups respectively. • Ulcer healing was significantly positively associated with: better adherence, device type (walker), less SINBAD score (2 or less), absence of ischemia, absence of infection, smaller ulcer area, superficial ulcer, better 4-week area reduction, and better blood glucose control. • The most important predictors were adherence, total SINBAD score and 4-week area reduction.
Key message: Knee-high walker had a better efficacy for healing compared to a cast-shoe for diabetic foot ulcers (81% vs 62% at 24 weeks). Adherence was also greater for the knee-high walker compared to the cast-shoe.
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