Non-Removable Cast Walkers Better for Treating Diabetic Foot Wounds

This simple modification dramatically improves healing over standard devices.

For patients with diabetic foot wounds, wrapping a removable cast walker with a cohesive bandage to improve compliance with pressure off-loading increases the proportion of ulcers that heal and the rate of healing, researchers report.

Dr. David G. Armstrong, of Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, stated that, “Wounds don’t heal very well with removable devices "because they are…removable."

In fact, he and his colleagues found that "people with wide open wounds on the bottom of their feet were only wearing their devices for an average of 28% of the steps they took each day."

"We postulated that the reason these removable devices weren’t working was because they weren’t being worn," he explained. "We therefore developed a device known as the ‘instant total contact cast’ (iTCC)" — that is, a removable cast walker (RCW) wrapped with a cohesive or plaster bandage to make removal difficult.

Dr. Armstrong’s group assessed the effectiveness of an RCW or an iTCC to heal neuropathic diabetic foot ulcerations in 50 patients. The subjects were followed weekly for 12 weeks or until wound healing.

On intent-to-treat analysis, 19 of 23 (82.6%) iTCC patients healed at 12 weeks, compared to 14 of 27 (51.9%) RCW patients (p = 0.02; OR = 1.8).

Also, patients in the iTCC group healed significantly sooner than those in the RCW group (41.6 days versus 58.0 days, respectively). No falls, device-related ulcerations, or hospitalizations were reported during the study.

No significant differences were observed between the groups in the proportion of patients requiring antibiotics to treat soft tissue infection during the evaluation period (27.3% of iTCC patients versus 41.7% of RCW patients).

Dr. Armstrong stated that, "The results of this study suggest strongly that this simple modification can dramatically improve healing over standard devices.” "Since most medical centers have access to this technology, they may now be able to potentially significantly improve the quality of wound care without incurring significant cost," he added.
Diabetes Care 2005;28:551-554.

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FACT:
Glucagon-like peptide 1 (GLP-1) is an incretin hormone secreted mainly by the entero-endocrine cells of the intestine in response to the presence of nutrients. It facilitates glucose-induced insulin release; analogues of GLP-1 are therefore of potential interest as a possible approach to the treatment of diabetes. GLP-1 also activates anti-apoptotic signalling pathways known to protect against myocardial injury. It has now been shown that GLP-1 protects against myocardial infarction in the isolated and intact rat heart, indicating a new therapeutic potential for this class of drugs.
Diabetes,54 (146-1510): Bose A, Mocanu M, Carr R, Brand C, Yellon D Glucagon-like peptide 1 can directly protect the heart against ischemia/reperfusion injury

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