Diabetic foot ulcers are a significant complication of diabetes, often requiring effective off-loading techniques to facilitate healing. A recent study evaluated the efficacy of three such methods: total contact casts (TCCs), healing sandals (HSs), and a removable boot with a shear-reducing foot bed (SRB). This 12-week randomized clinical trial compared these treatments in adults with diabetes and foot ulcers to determine which technique provides the most effective healing.
The study enrolled patients with diabetic forefoot ulcers and excluded those with severe health issues or conditions that would prevent the use of HSs or SRBs. The primary outcome was ulcer healing, defined as complete skin re-growth without drainage.
The results showed that total contact casts (TCCs) were the most effective, with approximately 70% of patients experiencing complete ulcer healing. When we Sandals Compare to TCCs, healing sandals (HSs) showed a healing rate of about 45%, which was not statistically different from TCCs. However, ulcers healed significantly faster with TCCs (around 5.4 weeks) compared to healing sandals (approximately 8.9 weeks). In contrast, the shear-reducing boot (SRB) showed the lowest healing rate, at only 22%, significantly less effective than TCCs.
Interestingly, patients using healing sandals were significantly more active, taking around 4000 steps per day, compared to those using TCCs or SRBs, who averaged about 1400 steps daily. This highlights a potential benefit of healing sandals in maintaining patient mobility during ulcer treatment.
In conclusion, while total contact casts remain the gold standard for achieving the highest proportion of healed diabetic foot ulcers and the fastest healing times, healing sandals provide a viable alternative, offering comparable healing rates to TCCs, albeit with a slightly longer healing duration. When we sandals compare to shear-reducing boots, sandals demonstrate superior efficacy. Furthermore, healing sandals allow for greater patient mobility, which can be an important consideration in treatment selection. The shear-reducing walker, on the other hand, proved to be the least effective method in this study.
