In addition to careful wound care, treatment of foot ulcers in people with diabetes involves different ways of reducing pressure on the site of the ulcer in order to avoid damaging newly forming cells. Two methods of minimizing weight-bearing and pressure are an off-loading cast and special shoe inserts that off-load the pressure. A study was undertaken to compare the improvement in 50 patients with plantar ulcers treated with either a fiberglass cast or a cloth shoe with a rigid insole designed to off-load pressure.

After 30 days, the ulcers had healed faster and significantly better in patients using the fiberglass cast. In 2 patients in the shoe group, the ulcers actually enlarged; this did not occur in any patients in the cast group. The number of ulcers completely healed after 30 days was 50% in the cast group vs 20.8% in the shoe insert group.

The investigators stressed 2 important benefits of the cast: the elimination of side effects including ulcers caused by the cast, and high patient acceptance.