Nonwindowed Nonremovable Fiberglass Off-Loading Cast Versus Removable Pneumatic Cast (AircastXP Diabetic Walker) in the Treatment of Neuropathic Noninfected Plantar Ulcers
A randomized prospective trial
- Carlo Caravaggi, MD12,
- Adriana Sganzaroli, MD1,
- Matteo Fabbi, MD1,
- Paola Cavaiani, MD1,
- Ileana Pogliaghi, MD1,
- Roberto Ferraresi, MD3,
- Francesca Capello, MD1 and
- Alberto Morabito, MD4
- 1Department of Diabetic Foot Pathology, Ospedale di Abbiategrasso, Milan, Italy
- 2IRCCS San Raffaele, University Vita Salute, Milan, Italy
- 3Department of Cardiology, Ospedale Policlinico, Milan, Italy
- 4Medical Statistic Unit, University of Milan, Milan, Italy
- Address correspondence and reprint requests to Carlo Caravaggi, Ospedale di Abbiategrasso, Diabetic Foot Pathology, Pz Mussi 1, Abbiategrasso (Milano) 20080, Italy. E-mail: carlo.caravaggi{at}fastwebnet.it
Neuropathic plantar ulcers are classical lesions secondary to diabetic polyneuropathy (1,2). The worldwide gold standard treatment is the nonremovable off-loading cast (3–5). However, the device is not widely used due to concerns related to risk factors of the off-loading cast (i.e., joint rigidity, additional ulcer formation beneath the cast, and infection of the ulcer enclosed in the cast). Our group recently demonstrated that it is possible to reduce the risk of side effects reported in literature by constructing the off-loading cast using fiberglass bandages of different rigidity. Considering the device’s scarce application because of the side effects, we conducted a controlled, randomized, prospective trial to evaluate the safety and efficacy of a removable pneumatic cast walker in comparison with a nonremovable fiberglass off-loading cast.
RESEARCH DESIGN AND METHODS
Between January 2005 and October 2005, 60 consecutive diabetic patients with neuropathic plantar ulcers were seen and randomly assigned to two groups: group A, using an Aircast Pneumatic Walker (XP Diabetic Walker); and group B, using the fiberglass off-loading cast.
All participants had peripheral neuropathy, as highlighted by insensitivity to 10 g monofilament and vibration perception threshold measured by biothesiometer at malleolus of at least 25 volts, and presented …
