Piaggesi et al. 2016
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Piaggesi A, Goretti C, Iacopi E, Clerici G, Romagnoli F, Toscanella F, Vermigli C. Comparison of Removable and Irremovable Walking Boot to Total Contact Casting in Offloading the Neuropathic Diabetic Foot Ulceration. Foot Ankle Int. 2016 Aug;37(8):855-61.
Design: Randomised Comparative Study Subjects: 60 patients with DFUs, Methods: Subjects were randomly assigned to 3 different offloading modalities: 1.Total contact casting (TCC) (group A), 2.Walking boot rendered irremovable (i-RWD; group B), 3.Removable walking boot (RWD; group C). The i-RWD and RWD were the same brace, just left removable in group C. Patients were followed up weekly for 90 days or up to complete re-epithelization. Outcomes: Ulcer survival, Healing time, Ulcer size reduction, adverse events, patients' acceptance and costs Results: • Mean healing time in the 3 groups did not differ (P = .5579). • Ulcer size reduction from baseline to the end of follow-up was significant (P < .01) in all groups without differences between the groups. • Seven patients in group A (35%), 2 in group B (10%), and 1 in group C (5%) (Fisher exact test P = .0436 group A vs group C) reported non-severe adverse events. • Patients' acceptance and costs were significantly better in group C (P < .05).
Key message: Walking boot was as effective as Total Contact Casting (TCC) on offloading the neuropathic Diabetic Foot Ulcers. Non-severe adverse events, patient acceptance and patient costs were significantly better with the removable brace compared to TCC.
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