Comparison of Forefoot Ulcer Healing Using Alternative Off-loading Methods in Patients with Diabetes Mellitus

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Abstract
To compare the healing rate of forefoot ulcers in patients with diabetes treated using a total contact cast with those treated using alternative off-loading methods. DESIGN Retrospective analysis of healing rates of forefoot ulcers. Louisiana State University Health Sciences Center Diabetes Foot Program, Baton Rouge, LA. 120 consecutive patients with diabetes mellitus referred for treatment of new, nonsurgical forefoot ulceration. Alternative off-loading methods (an accommodative dressing, a healing shoe, a walking splint) or a total contact cast. Healing time of forefoot ulcers in days and percentage healed in 12 weeks. 113 of 120 (94%) patients with forefoot ulcers healed in an average of 45.5 +/- 43.4 days. Seven of 120 (5.8%) patients with ulcers either did not heal or were lost to follow-up. Stepwise lognormal regression showed ulcer grade (P <.001, R(2)= 0.11) and width (P =.024, R(2)= 0.05) were significantly related to healing time. After adding ulcer grade (1, 2, or 3) and width into the model, there was no difference between healing time in the accommodative dressing (P =.253), healing shoe (P =.815), and walking splint (P =.525) when compared with the total contact cast. Forefoot ulcers were closed within 12 weeks in at least 81% of cases irrespective of the off-loading method. The healing rate of forefoot ulcerations in patients with diabetes using alternative off-loading methods or a total contact cast appeared to be comparable when the method was selected based on location of ulcer, patient age, and duration of ulceration.