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Total contact casts were better than removable cast walkers or half shoes for healing diabetic neuropathic foot ulcers

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QUESTION: In patients with diabetes, what is the effectiveness of total contact casts (TCCs), removable cast walkers (RCWs), and half shoes for healing neuropathic foot ulcerations?


Randomised {allocation concealed}*, unblinded, controlled trial with up to 12 weeks of follow up.




75 patients with diabetes who had clinically significant loss of protective sensation (>25 V) as measured with a biothesiometer, ≥1 palpable foot pulse or a transcutaneous oximetry measurement > 40 mm Hg at the dorsum of the fore foot, and a superficial neuropathic plantar diabetic foot ulcer corresponding to grade 1A (University of Texas Diabetic Wound Classification System). Exclusion criteria were active infection; wounds in locations on the heel, rear foot, or area other than the plantar aspect of the foot; severe peripheral vascular …

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  • Sources of funding: US Department of Veterans Affairs Rehabilitation R&D Merit Award and Aircast Research Foundation.

  • For correspondence: Dr D G Armstrong, Department of Surgery, Southern Arizona Veterans Affairs Medical Center, 3601 South Sixth Ave, Tucson, AZ 85723, USA. Fax +1 520 629 4603.