A cast-boot ankle foot orthosis decreases plantar pressures under the forefoot more effectively than a total contact cast, but its relative effectiveness for ulcer healing is still a function of compliance, according to research from Washington University in St. Louis.
Investigators randomized 23 patients with diabetic neuropathy and a foot ulcer to treatment with either a cast-boot AFO or a total contact cast. Plantar pressure distribution was analyzed as subjects walked across a six-meter walkway at a self-selected speed.
In the forefoot, the AFO was associated with significantly lower estimated marginal mean values for maximum force, force-time integral, peak pressure, and pressure-time integral. In the hindfoot, there was a trend in favor of the TCC for force-time integral; no other differences approached significance.
However, healing rates told a different story. Nine of 11 patients in the TCC group experienced ulcer healing, compared to just five of 12 in the AFO group. The results, presented in August at the emed Scientific Meeting, underscore the importance of patient compliance for ulcer management.