Objective: To evaluate the efficacy of a removable cast walker compared to non-removable fiberglass off-bearing cast in the treatment of diabetic plantar foot ulcer.

Research design and methods: Forty-five adult diabetic patients with non-ischemic, non-infected neuropathic plantar ulcer were randomized for treatment with a non-removable fiberglass off-bearing cast (TCC group) or walker cast (Stabil-D group). Treatment duration was 90 days. Percent reduction in ulcer surface area and total healing rates were evaluated after treatment.

Results: A total of 48 patients were screened; however, two patients in the TCC group and one in the Stabil-D group did not complete the study and were considered dropouts. There were no significant differences in demographic and clinic characteristics of the 45 patients completing the study. Ulcer surface decreased from 1.41 cm² to 0.21 cm² (P < 0.001) in the TCC group and from 2.18 cm² to 0.45 cm² (P < 0.001) in the Stabil-D group, with no significant differences between groups (P = 0.722). Seventeen patients (73.9%) in the TCC group and 16 patients (72.7%) in the Stabil-D group achieved healing (P = 0.794). Average healing time was 35.3 ± 3.1 days and 39.7 ± 4.2 days in the TCC and Stabil-D group, respectively (P = 0.708).

Conclusions: The Stabil-D cast walker, although removable, was equivalent in efficacy to TCC in terms of ulcer size reduction and total healing rate. The easier use of Stabil-D may help increase the use of off-loading devices in the management of plantar neuropathic diabetic foot ulcers.