***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE A limited number of clinical trials have shown that the total contact cast ( TCC ) is an effective treatment in neuropathic , noninfected , and nonischemic foot ulcers . In this prospect i ve data collection study , we assessed outcome and complications of  TCC treatment in neuropathic patients with and without peripheral arterial disease ( PAD ) or ( superficial ) infection . RESEARCH DESIGN AND METHODS Ninety-eight consecutive patients selected for casting were followed until healing ; all had polyneuropathy , 44 % had PAD , and 29 % had infection . Primary outcomes were percentage healed with a cast , time to heal , and number of complications . RESULTS Ninety percent of all nonischemic ulcers without infection and 87 % with infection healed in the cast ( NS ) . In patients with PAD but without critical limb ischemia , 69 % of the ulcers without infection and 36 % with infection healed ( P < 0.01 ) . In multivariate analyses , PAD , infection , and heel ulcers were associated with a lower percentage healed ( all P < 0.05 ) . Median duration of cast treatment was 34 days . New ulcers , all superficial , developed in 9 % and preulcerative lesions in 28 % of the patients ; these skin lesions healed in the cast within a maximum of 13 days . CONCLUSIONS In comparison to pure neuropathic ulcers , ulcers with moderate ischemia or infection can be treated effectively with casting . However , when both PAD and infection are present or the patient has a heel ulcer , outcome is poor and alternative strategies should be sought . The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment OBJECTIVE The purpose of this study was to compare the effectiveness of a removable cast walker ( RCW ) rendered irremovable ( iTCC ) with the total contact cast ( TCC ) in the treatment of diabetic neuropathic plantar foot ulcers . RESEARCH DESIGN AND METHODS In a prospect i ve , r and omized , controlled trial , 41 consecutive diabetic patients with chronic , nonischemic , neuropathic plantar foot ulcers were r and omly assigned to one of two groups : a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material ( i.e. , an iTCC ) or a st and ard TCC . Primary outcome measures were the proportion of patients with ulcers that healed at < /=12 weeks , healing rates , complication rates , cast placement/removal times , and costs . RESULTS The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74 % , respectively ( 94 and 93 % , respectively , when patients who were lost to follow-up were excluded ) . Survival analysis ( healing rates ) was statistically equivalent in the two groups , as were complication rates , but with a trend toward benefit in the iTCC group . The iTCC took significantly less time to place and remove than the TCC with 39 % and 36 % reductions , respectively . There was also an overall lower cost associated with the use of the iTCC compared with the TCC . CONCLUSIONS The iTCC may be equally efficacious , faster to place , easier to use , and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers Neuropathic  plantar ulcers  are classical lesions secondary to diabetic polyneuropathy ( 1,2 ) . The worldwide gold st and ard treatment is the nonremovable off-loading cast ( 3–5 ) . However , the device is not widely used due to concerns related to risk factors of the off-loading cast ( i.e. , joint rigidity , additional ulcer formation beneath the cast , and infection of the ulcer enclosed in the cast ) . Our group recently demonstrated that it is possible to reduce the risk of side effects reported in literature by constructing the off-loading cast using fiberglass b and ages of different rigidity . Considering the device ’s scarce application because of the side effects , we conducted a controlled , r and omized , prospect i ve trial to evaluate the safety and efficacy of a removable pneumatic cast walker in comparison with a nonremovable fiberglass off-loading cast .  Between January 2005 and October 2005 , 60 consecutive diabetic patients with neuropathic plantar ulcers were seen and r and omly assigned to two groups : group A , using an Aircast Pneumatic Walker ( XP Diabetic Walker ) ; and group B , using the fiberglass off-loading cast .  All participants had peripheral neuropathy , as highlighted by insensitivity to 10 g monofilament and vibration perception threshold measured by biothesiometer at malleolus of at least 25 volts , and presented OBJECTIVE —This study was design ed to test the safety , effectiveness , and costs of off-loading with a novel , off-the-shelf irremovable device in the management of diabetic foot ulceration ( DFU ) . RESEARCH DESIGN AND METHODS —We prospect ively evaluated off-loading of neuropathic plantar ulcers in 40 diabetic out patients attending our diabetic foot clinic and compared healing rates at the 12-week follow-up , number and severity of adverse events , healing time , costs and applicability of the device , and patients ’ satisfaction between those r and omly assigned to total contact casting ( TCC ; group A ) or to the Optima Diab walker ( group B ) . Deep or infected ulcers were excluded . RESULTS —No difference between groups A and B was observed in healing rates at 12 weeks ( 95 vs. 85 % ) , healing time ( 6.5 ± 4.4 vs. 6.7 ± 3.4 weeks ) , and number of adverse events ( six versus four ) . Treatment was significantly less expensive in group B , which showed a mean reduction of costs of 78 % compared with group A ( P < 0.001 ) . Practicability was more favorable in group B , with a reduction of 77 and 58 % of the time required for application and removal of the devices , respectively ( P < 0.001 ) . Patients ’ satisfaction with the treatment was higher in group B ( P < 0.01 ) . CONCLUSIONS —The Optima Diab walker is as safe and effective as TCC in the management of DFU , but its lower costs and better applicability may be of help in spreading the practice of off-loading among the centers that manage the diabetic foot OBJECTIVE To compare the efficacy , safety , and compliance of a nonremovable fiberglass cast boot and off-loading shoes in the treatment of  diabetic plantar ulcers .  RESEARCH DESIGN AND METHODS Patients ( n = 93 ) with noninfected , nonischemic plantar ulcers were included in this prospect i ve nonr and omized study . Treatment used a nonremovable fiberglass cast boot for longer st and ing and deeper ulcers ( n = 42 ) and a half shoe or heel-relief shoe for other ulcers ( n = 51 ) . We evaluated off-loading therapy , compliance , and complications in both groups . RESULTS The healing rate was significantly higher with the cast boot than with the off-loading shoe ( 81 vs. 70 % , P = 0.017 ) , with healing times of 68.6 + /- 35.1 vs. 134.2 + /- 133.0 days , respectively , and hazard ratio 1.68 ( 95 % CI 1.04 - 2.70 ) ; complete compliance with treatment was 98 vs. 10 % ( P = 0.001 ) , respectively . Secondary osteomyelitis developed in 3 patients in the cast boot group and 13 patients in the off-loading shoe group ( P = 0.026 ) . CONCLUSIONS A nonremovable fiberglass cast boot was effective in healing diabetic plantar ulcers and in decreasing the risk of secondary osteomyelitis . The cast boot forced compliance with off-loading , thus promoting healing OBJECTIVE To evaluate the efficacy of a removable cast walker compared with that of a nonremovable fiberglass off-bearing cast in the treatment of diabetic plantar foot ulcer . RESEARCH DESIGN AND METHODS Forty-five adult diabetic patients with nonischemic , noninfected neuropathic plantar ulcer were r and omly assigned for treatment with a nonremovable fiberglass off-bearing cast ( total contact cast [ TCC ] group ) or walker cast ( Stabil-D group ) . Treatment duration was 90 days . Percent reduction in ulcer surface area and total healing rates were evaluated after treatment . RESULTS A total of 48 patients were screened ; however , 2 patients in the TCC group and 1 patient in the Stabil-D group did not complete the study and were considered dropouts . There were no significant differences in demographic and clinic characteristics of the 45 patients completing the study .  Ulcer surface decreased from 1.41 to 0.21 cm2 ( P < 0.001 ) in the TCC group and from 2.18 to 0.45 cm2 ( P < 0.001 ) in the Stabil-D group , with no significant differences between groups ( P = 0.722 ) . Seventeen patients ( 73.9 % ) in the TCC group and 16 patients ( 72.7 % ) in the Stabil-D group achieved healing ( P = 0.794 ) . Average healing time was 35.3 ± 3.1 and 39.7 ± 4.2 days in the TCC and Stabil-D group , respectively ( P = 0.708 ) . CONCLUSIONS The Stabil-D cast walker , although removable , was equivalent in efficacy to the TCC in terms of ulcer size reduction and total healing rate . The easier use of Stabil-D may help increase the use of off-loading devices in the management of plantar neuropathic diabetic foot ulcers The objective of this study was to compare the effectiveness of irremovable total-contact casts ( TCC ) and custom-made temporary footwear ( CTF ) to heal  neuropathic foot ulcerations in individuals with diabetes . In this prospect i ve clinical trial , 43 patients with plantar ulcer Grade 1 or 2 ( Wagner scale ) were r and omized to one of two off-loading modalities : TCC or CTF . Outcomes assessed were wound surface area reduction ( cm2 ) and time to wound healing ( days ) at 2 , 4 , 8 and 16 weeks . To evaluate safety , possible side effects were recorded at each follow-up visit . The results showed no significant difference in wound surface area reduction ( adjusted for baseline wound surface ) at 2 , 4 , 8 or 16 weeks ( adjusted mean difference 0.10 cm2 ; 95 % CI −0.92−0.72 at 16 weeks ) . At 16 weeks , 12 patients had a completely healed ulcer , 6 per group . The median time to healing was shorter for the patients using a cast ( 52 vs. 90 days , p = 0.26 ) . Five patients with TCC and two with CTF developed device-related complications . It was concluded that : ( i ) the rate of wound healing is not significantly different for patients treated with CTF or TCC . The difference in wound surface area was small and not significant at any time during follow-up ; and ( ii ) the difference in healing time ( 38 days ) may have attained statistical significance if the numbers in these sub-groups ( 2 × 6 ) had been higher . Since there appears to be little difference in effectiveness between both off-loading modalities , further investigation into the benefits of CTF is warranted OBJECTIVE The purpose of this study was to evaluate the effectiveness of a removable cast walker ( RCW ) and an " instant " total contact cast ( iTCC ) in healing  neuropathic diabetic foot ulcerations .  RESEARCH DESIGN AND METHODS We r and omly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups : an RCW or the same RCW wrapped with a cohesive b and age ( iTCC ) so patients could not easily remove the device . Subjects were evaluated weekly for 12 weeks or until wound healing . RESULTS An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group ( 82.6 vs. 51.9 % , P = 0.02 , odds ratio 1.8 [ 95 % CI 1.1 - 2.9 ] ) . Of the patients with ulcers that healed , those treated with an iTCC  healed significantly sooner ( 41.6 + /- 18.7 vs. 58.0 + /- 15.2 days , P = 0.02 ) . CONCLUSIONS Modification of a st and ard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds OBJECTIVE To compare the effectiveness of total contact casts , commercially available therapeutic shoes , and removable walking casts to reduce mean peak plantar foot pressures at the site of neuropathic ulcerations in diabetic subjects . RESEARCH DESIGN AND METHODS We compared the reduction in peak plantar pressures at ulcer sites under the great toe ( n = 5 ) , first metatarsal ( n = 10 ) , and second through fifth metatarsals ( n = 10 ) using six treatments : total contact casts ( TCCs ) , DH Pressure Relief Walkers ( DH ) , Aircast Pneumatic Walkers , Three D Dura-Steppers ( 3D ) , CAM Walkers , and P.W. Minor Xtra Depth shoes . A rubber sole canvas oxford was used to establish 
    Output:
    
In conclusion , non-removable off-loading devices regardless of type , are more likely to result in ulcer healing  than removable off-loading devices , presumably because patient compliance with off-loading is facilitated