Titre du document / Document title

Off-loading the diabetic foot wound: A randomized clinical trial

Auteur(s) / Author(s)

ARMSTRONG David G. ^{(1 2 3 4)} ; NGUYEN Hienvu C. ⁽²⁾ ; LAVERY Lawrence A. ⁽²⁾ ; VAN SCHIE Carine H. M. ⁽³⁾ ; BOULTON Andrew J. M. ⁽³⁾ ; HARKLESS Lawrence B. ⁽²⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Audie L. Murphy Veterans Affairs Medical Center, Tucson, Arizona, ETATS-UNIS
⁽²⁾ Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas, ETATS-UNIS
⁽³⁾ Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, ROYAUME-UNI
⁽⁴⁾ Department of Surgery, Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona, ETATS-UNIS

Résumé / Abstract

OBJECTIVE - To compare the effectiveness of total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes to heal neuropathic foot ulcerations in individuals with diabetes. RESEARCH DESIGN AND METHODS - In this prospective clinical trial, 63 patients with superficial noninfected, nonischemic diabetic plantar foot ulcers were randomized to one of three off-loading modalities: TCC, half-shoe, or RCW. Outcomes were assessed at wound healing or at 12 weeks, whichever came first. Primary outcome measures included proportion of complete wound healing at 12 weeks and activity (defined as steps per day). RESULTS - The proportions of healing for patients treated with TCC, RCW, and half-shoe were 89.5, 65.0, and 58.3%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities (89.5 vs. 61.4%, P = 0.026, odds ratio 5.4, 95% Cl 1.1-26.1). There was also a significant difference in survival distribution (time to healing) between patients treated with a TCC and both an RCW (P = 0.033) and half-shoe (P = 0.012). Patients were significantly less active in the TCC (600.1 ± 320.0 daily steps) compared with the half-shoe (1,461.8 ± 1,452.3 daily steps, P = 0.04). There was no significant difference in the average number of steps between the TCC and the RCW (767.6 ± 563.3 daily steps, P = 0.67) or the RCW and the half-shoe (P = 0.15). CONCLUSIONS - The TCC seems to heal a higher proportion of wounds in a shorter amount of time than two other widely used off-loading modalities, the RCW and the half-shoe.

Revue / Journal Title

Diabetes care   ISSN 0149-5992   CODEN DICAD2 

Source / Source

2001, vol. 24, n^o6, pp. 1019-1022 (26 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Diabetes Association, Alexandria, VA, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Ulcer ; Foot ; Peripheral neuropathy ; Diabetes mellitus ; Cicatrization ; Treatment efficiency ; Shoe ; Subatmospheric pressure ; Adult ; Lower limb ; Human ; Skin disease ; Nervous system diseases ; Peripheral nerve disease ; Endocrinopathy ;

Mots-clés français / French Keywords

Ulcère ; Pied ; Neuropathie périphérique ; Diabète ; Cicatrisation ; Efficacité traitement ; Chaussure ; Pression réduite ; Adulte ; Membre inférieur ; Homme ; Peau pathologie ; Système nerveux pathologie ; Nerf périphérique pathologie ; Endocrinopathie ;

Mots-clés espagnols / Spanish Keywords

Ulcera ; Pie ; Neuropatía periférica ; Diabetes ; Cicatrización ; Eficacia tratamiento ; Calzado ; Presión reducida ; Adulto ; Miembro inferior ; Hombre ; Piel patología ; Sistema nervioso patología ; Nervio periférico patología ; Endocrinopatía ;

Localisation / Location

INIST-CNRS, Cote INIST : 18054, 35400009890857.0090