Can an alternative off-loading strategy improve healing outcomes in plantar diabetic foot ulcers (DFU)? A parallel-group, open-label, single-center randomized controlled trial published in Diabetes Research and Clinical Practice compared posterior slab cast (PSC) with total contact cast (TCC) in 99 adults with type 2 diabetes mellitus (T2DM) and neuropathic plantar DFU.

Adults with a single neuropathic Wagner grade 2 or 3 plantar DFU were randomly assigned to PSC (n = 48) or TCC (n = 51). The primary endpoint was wound healing rate at 6 months. Secondary endpoints included reduction in ulcer surface area at 4 weeks, wound healing rate at 3 months, and patient satisfaction assessed using a Likert scale.

At 6 months, wound healing occurred more frequently with PSC (72.9%) compared with TCC (49%), with a hazard ratio of 1.3 (95% CI 1.03–1.73; P = 0.024). At 3 months, healing rates were also higher with PSC (50%) compared with TCC (25.5%) (P = 0.011).

Reduction in ulcer surface area at 4 weeks from baseline was greater with PSC (63.2 ± 15.5%) than with TCC (55.6 ± 18.9%) (P = 0.040). Patient satisfaction scores were higher with PSC than with TCC (4.0 ± 1.2 vs 2.5 ± 1.1; P < 0.001).

Compared with TCC, PSC showed higher wound healing rates in neuropathic plantar DFU and was associated with greater patient satisfaction. The findings may relate to differences in application and access for wound monitoring and intervention, and further studies are required to confirm these results.