Comparison of Forefoot Ulcer Healing Using Alternative Off-loading Methods in Patients with Diabetes Mellitus

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OBJECTIVETo compare the healing rate of forefoot ulcers in patients with diabetes treated using a total contact cast with those treated using alternative off-loading methods.DESIGNRetrospective analysis of healing rates of forefoot ulcers.SETTINGLouisiana State University Health Sciences Center Diabetes Foot Program, Baton Rouge, LA.PARTICIPANTS120 consecutive patients with diabetes mellitus referred for treatment of new, nonsurgical forefoot ulceration.INTERVENTIONSAlternative off-loading methods (an accommodative dressing, a healing shoe, a walking splint) or a total contact cast.MAIN OUTCOME MEASUREHealing time of forefoot ulcers in days and percentage healed in 12 weeks.RESULTS113 of 120 (94%) patients with forefoot ulcers healed in an average of 45.5 ± 43.4 days. Seven of 120 (5.8%) patients with ulcers either did not heal or were lost to follow-up. Stepwise lognormal regression showed ulcer grade (P <.001, R2 = 0.11) and width (P = .024, R2 = 0.05) were significantly related to healing time. After adding ulcer grade (1, 2, or 3) and width into the model, there was no difference between healing time in the accommodative dressing (P = .253), healing shoe (P = .815), and walking splint (P = .525) when compared with the total contact cast. Forefoot ulcers were closed within 12 weeks in at least 81% of cases irrespective of the off-loading method.CONCLUSIONThe healing rate of forefoot ulcerations in patients with diabetes using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration.

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