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Posterior slab cast shows higher healing rate than total contact cast for diabetic foot ulcers in single-center RCTPosterior slab cast may heal diabetic foot ulcers faster than total contact cast in small trial

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Key Takeaway
Consider posterior slab cast as a potential off-loading alternative for plantar diabetic ulcers, but note limited trial evidence.

This single-center, open-label randomized controlled trial enrolled 99 adults with Type 2 diabetes who had a single neuropathic Wagner grade 2 or 3 plantar diabetic foot ulcer. Participants were randomized to receive either a posterior slab cast (PSC) or a total contact cast (TCC) for off-loading, with follow-up for 6 months. The primary outcome was wound healing rate at 6 months, which was significantly higher in the PSC group (72.9%, 35/48) compared to the TCC group (49%, 25/51), with a hazard ratio of 1.3 (95% CI: 1.03-1.73, P=0.024). Secondary outcomes also favored PSC, including a higher healing rate at 3 months (50% vs 25.5%, P=0.011), greater percentage reduction in ulcer surface area at 4 weeks (63.2% vs 55.6%, P=0.040), and significantly better patient satisfaction scores (4.0 vs 2.5 on a Likert scale, P<0.001). Safety and tolerability data, including adverse events and discontinuations, were not reported. Key limitations include the single-center design and open-label nature, which may introduce bias. The study does not report on long-term outcomes beyond 6 months, complications, or cost-effectiveness. While PSC may represent a more acceptable off-loading alternative to TCC in this specific population, these results are preliminary and require confirmation in larger, multi-center trials with blinded assessment.

Researchers conducted a small study with 99 adults who had Type 2 diabetes and a specific type of foot ulcer on the bottom of the foot. They wanted to see if a newer type of cast, called a posterior slab cast (PSC), worked as well as the standard total contact cast (TCC) for taking pressure off the wound to help it heal.

After six months, more wounds had healed in the group using the posterior slab cast (about 73%) compared to the group using the total contact cast (about 49%). Patients also reported being more satisfied with the newer cast. The study did not report any information about safety problems, side effects, or how easy the casts were to live with day-to-day.

The main reason to be careful is that this was a small, single-center study where both the patients and doctors knew which cast was being used. This can sometimes influence results. The findings are promising, but they need to be checked in larger, more rigorous studies that also look at safety and long-term outcomes. For now, this suggests the posterior slab cast could be a helpful alternative, but it is not yet proven to be the new standard of care.

What this means for you:
A newer type of cast showed promise for healing foot ulcers in a small study, but more research is needed.

Study Details

Study typeRct
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
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.
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