Posterior slab cast shows higher healing rate than total contact cast for diabetic foot ulcers in single-center RCT

BACKGROUND: Total contact cast (TCC) is the 'reference-standard' for off-loading plantar diabetic foot ulcers (DFU). Practical limitations, associated complications, and lack of patient acceptability, limits its widespread use. Posterior slab cast (PSC) may provide an alternate way of off-loading the foot that might be more acceptable, and better tolerated, by people with DFU. AIM: To compare wound healing and foot related outcomes in people with plantar DFU using TCC or PSC for off-loading the foot. METHOD: This was a parallel-group, open-label, single-centre randomized controlled trial. Ninety-nine adults with Type 2 diabetes (T2D) with a single neuropathic Wagner grade 2 or 3 plantar DFU were randomly assigned to receive either a PSC (n = 48) or a TCC (n = 51) for off-loading the foot. The primary endpoint was wound healing rate at 6 months. Secondary endpoints included reduction in ulcer surface area at 4 weeks, wound healing rate at 3 months, and patient satisfaction with either off-loading strategy. RESULTS: The wound healing rate of DFU at 6 months among subjects using PSC (72.9%) was significantly greater than that seen among those using TCC (49%) [HR: 1.3 (1.03-1.73) (P = 0.024)]. Similarly, the wound healing rate at 3 months was also greater among subjects using PSC (50%) as compared to those on TCC (25.5%) (P = 0.011). The percentage reduction of ulcer surface area at 4 weeks from baseline was significantly higher among subjects using PSC (63.2 ± 15.5%) as compared to those using TCC (55.6 ± 18.9%) (P = 0.040). Patient satisfaction, assessed using the Likert scale, was significantly better among subjects using PSC when compared to those using TCC (4.0 ± 1.2 vs 2.5 ± 1.1 respectively, P < 0.001) CONCLUSION: Compared to TCC, PSC was more effective in healing neuropathic plantar DFUs, likely due to its less cumbersome application technique and providing easier access for wound monitoring and intervention when required. Further studies are needed to validate these results.