Treatment of chronic plantar ulcer of the diabetic foot using an irremovable windowed fibreglass cast boot: prospective study of 177 patients. Issue 7 (25th June 2015)

• Record Type: Journal Article
• Authors: Ha Van, Georges; Michaux, Caroline; Parquet, Hugues; Bourron, Olivier; Pradat‐Diehl, Pascale; Hartemann, Agnes
• Is Part Of: Diabetes/metabolism research and reviews. Volume 31:Issue 7(2015:Oct.)
• Page Start: 691
• Page End: 698
• Publication Date: 2015-06-25
• Subjects: Diabetes -- Periodicals; Metabolism -- Periodicals; 616.642
• DOI: 10.1002/dmrr.2657
• Languages: English
• ISSNs: 1520-7552

Abstract

<abstract abstract-type="main"> <title>Summary</title> <p>The objective of this study was to evaluate the level of healing of chronic neuropathic plantar ulcers, using an irremovable windowed fibreglass cast boot, which is only opened after healing. A single‐centre prospective study of a cohort of 177 diabetic patients with chronic neuropathic plantar ulcers was carried out. The duration of neuropathic plantar ulcers was 604 ± 808 days, with a mean surface area of 4.6 ± 6.5 cm<sup>2</sup>, a mean depth of 1.04 ± 1.08 cm and a mean volume of 5.9 ± 17.7 cm<sup>3</sup>. After a mean of 96 days of wearing a windowed fibreglass cast boot (min 9 days, max 664 days and median 68 days), the level of healing reached 83.6%, although 29 patients did not heal (16.4%). The compliance was at 95%. NPUs with bigger volumes (<italic>p</italic> = 0.037) and those located at the heels ( <italic>p</italic> = 0.004) had significantly lower healing levels. Twenty‐one patients had moderate peripheral arterial disease (12%), and 24 patients were ostectomized for underlying osteomyelitis (14%), before inclusion. Moderate peripheral arterial disease (<italic>p</italic> = 0.970) or operated osteomyelitis (<italic>p</italic> = 0.128) did not modify the level of healing significantly, which were of 81% and 70.8%, respectively. Complications include 12 ulcers due to the windowed fibreglass cast boot (i.e. 7%) and two other ulcers being moderately infected, resulting in 2% of toe amputation, but there was no major amputation or phlebitis. The treatment of old and deep NPUs of the diabetic foot by wearing a windowed fibreglass cast boot without opening the boot prior to healing offers very high ulcer recovery levels. Windowed fibreglass cast boots were changed in only 26 cases (14.6%). In addition, compliance was excellent and of the order of 95%. Furthermore, moderate peripheral arterial disease or a recent ostectomy did not affect the efficacy of windowed fibreglass cast boot. Copyright © 2015 John Wiley & Sons, Ltd.</p> </abstract>