A Cochrane review included 14 studies with a total of 709 subjects. One study compared two different types of non-removable casts with no discernable difference between the groups. Seven studies (n=366) compared non-removable casts with removable pressure-relieving devices. Non-removable casts were associated with a statistically significant increase in the number of ulcers healed compared with the removable device (RR 1.17, 95% CI 1.01 to 1.36; 5 studies, n=230). Two studies (n=98) found that significantly more ulcers healed with non-removable casts than with dressings alone. Achilles tendon lengthening combined with a non-removable cast in one study resulted in significantly more healed ulcers at 7 months than non-removable cast alone (RR 2.23, 95% CI 1.32 to 3.76). More ulcers remained healed at two years in this group (RR 3.41, 95% CI 1.42 to 8.18). Other comparisons included surgical debridement of ulcers; felt fitted to the foot; felted foam dressings and none of these showed a statistically significant treatment effect in favour of the intervention.
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).