Researchers in the United Kingdom reviewed data from 14 randomized controlled trials (709 participants) and compared and evaluated the effects of pressure-relieving interventions on the healing of diabetes-related plantar foot ulcers and found that nonremovable casts are more effective than removable casts or dressings alone. If left untreated, the ulcers can cause tissue damage and even lead to amputation.
The principles of successful treatment are to address three main criteria: to ensure a sufficient blood supply to the area, to treat any underlying infection aggressively, and to achieve good pressure relief.
Nonremovable pressure-relieving casts were compared to dressings alone, temporary therapeutic shoes, removable pressure-relieving devices, and surgical lengthening of the Achilles tendon. Other comparisons that did not provide a statistically significant effect in favor of the intervention included surgical debridement, callus removal, felt fitted to the foot; and felted foam dressings.
Seven studies (366 participants) compared non-removable casts with removable pressure-relieving devices. In five of these studies, non-removable casts were associated with a statistically significant increase in the number of ulcers healed compared with the removable device. Two studies (98 participants) found that significantly more ulcers healed with nonremovable casts than with dressings alone. One study in the review compared two different types of nonremovable casts and found no difference between the groups. Achilles tendon lengthening combined with a nonremovable cast in one study of forefoot ulcers resulted in significantly more healed ulcers at seven months than a nonremovable cast alone, and more ulcers remained healed at two years in this group.
Five of the studies reviewed were based in the United States, five in Italy, and one each in Germany, the Netherlands, Australia, and India.
Complete details of the literature review, methodology, and implications for practice and research can be found in the article “Pressure-Relieving Interventions for Treating Diabetic Foot Ulcers,” published in the Cochrane Database of Systematic Reviews.
