Nonremovable, Windowed, Fiberglass Cast Boot in the Treatment of Diabetic Plantar Ulcers

Efficacy, safety, and compliance Georges Ha Van, MD1, Hubert Siney, MD2, Agnes Hartmann-Heurtier, MD1, Sophie Jacqueminet, MD1, Françoise Greau1 and André Grimaldi, MD1
1 Department of Diabetology and Metabolism, Pitié-Salpêtrière Teaching Hospital, Paris, France2 Computer Sciences Department, Saint-Vincent-de-Paul Teaching Hospital, Paris, France
Correspondence: Address correspondence and reprint requests to Georges Ha Van, MD, Service de Diabétologie Métabolisme Pr Grimaldi, Groupe Hospitalier Pitié-Salpétrière, 47-83 Boulevard de l’Hôpital, 75013 Paris, France. E-mail: ghavan@club-internet.fr
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OBJECTIVE—To compare the efficacy, safety, and compliance of a nonremovable fiberglass cast boot and off-loading shoes in the treatment of diabetic plantar ulcers.
RESEARCH DESIGN AND METHODS—Patients (n = 93) with noninfected, nonischemic plantar ulcers were included in this prospective nonrandomized study. Treatment used a nonremovable fiberglass cast boot for longer standing and deeper ulcers (n = 42) and a half shoe or heel-relief shoe for other ulcers (n = 51). We evaluated off-loading therapy, compliance, and complications in both groups.
RESULTS—The healing rate was significantly higher with the cast boot than with the off-loading shoe (81 vs. 70%, P = 0.017), with healing times of 68.6 ± 35.1 vs. 134.2 ± 133.0 days, respectively, and hazard ratio 1.68 (95% CI 1.04–2.70); complete compliance with treatment was 98 vs. 10% (P = 0.001), respectively. Secondary osteomyelitis developed in 3 patients in the cast boot group and 13 patients in the off-loading shoe group (P = 0.026).
CONCLUSIONS—A nonremovable fiberglass cast boot was effective in healing diabetic plantar ulcers and in decreasing the risk of secondary osteomyelitis. The cast boot forced compliance with off-loading, thus promoting healing.