Diabetic plantar ulcers heal just as well with removable walker casts as with nonremovable fiberglass total-contact casts, a new study reveals.

The researchers say the removable cast could be a good option when patients cannot have a nonremovable total-contact cast and they present a long list of such patients: those with infection or critical ischemia, those who are very elderly or have problems with vision or equilibrium, and those with a contralateral foot ulcer or varicose veins.

Dr. Giacomo Clerici of IRCCS Multimedica in Sesto San Giovanni, Milan, Italy, and colleagues describe a study in which they randomized 48 patients with nonischemic, noninfected neuropathic plantar ulcer to either a removable walker cast (Stabil-D) or a nonremovable total contact cast (the control group).

Among the 23 patients in the control group, average ulcer surface area shrank from 1.41 sq. cm at baseline to 0.2 sq. cm after treatment. In the 22 Stabil-D group patients, mean ulcer area shrank from 2.18 to 0.45 sq. cm. There was no difference between the two groups in ulcer surface area change.

Seventeen controls and 16 Stabil-D subjects achieved healing of the ulcer. Average healing times were similar: 35.3 days in the control group and 39.7 days in the Stabil-D group.

“Because this study is a noninferiority trial, we cannot say that the use of a removable walker should be the treatment of choice for patients with neuropathic ulcers,” Dr. Clerici said.

Dr. Clerici added that a patient’s likely compliance with a removable cast could be the deciding factor. “I would suggest a removable walker for patients with high compliance and a (total contact cast) or nonremovable walker for patients with poor compliance.”

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