Comparison of posterior slab cast with total contact cast in the management of diabetic foot ulcers: A randomized controlled trial.
By: G. Goyal, U.B. Bose, R. Srivastava, S. Majumder, J.J. Mukherjee, E.B. Jude | Published in: Diabetes Research and Clinical Practice | February 2026
[No openly-licensed figure was available for this post.]
When it comes to offloading a plantar diabetic foot ulcer, the total contact cast (TCC) has long worn the crown. Guidelines call it the “gold standard” — a close-fitting plaster or fibreglass shell that keeps pressure off the wound and, crucially, keeps it off because the patient can’t easily remove it. The trouble is that TCC is inconvenient, requires skilled application, limits wound inspection, and many patients simply won’t tolerate it. In practice, fewer than a quarter of clinics use it routinely. So the question that has nagged researchers for years is: is there something simpler that works just as well — or better?
A team from ILS Hospital and Apollo Multispecialty Hospitals in Kolkata, India, collaborated with UK diabetologist Edward Jude to put that question to a proper head-to-head test. Their single-centre randomised controlled trial enrolled 99 adults with Type 2 diabetes and a single neuropathic plantar ulcer (Wagner grade 2 or 3), assigning 48 to a posterior slab cast (PSC) — a partial back-slab applied to the sole and heel — and 51 to standard TCC. All participants wore a removable ankle-high device on top. The headline result was striking: at six months, 72.9% of the PSC group had healed, compared with only 49% in the TCC group (hazard ratio 1.3, p = 0.024). At three months, the PSC group was already at 50% healing vs 25.5% for TCC. Wound area shrank faster too — 63.2% reduction at four weeks for PSC vs 55.6% for TCC. And on patient satisfaction, PSC scored 4.0 out of 5 vs 2.5 for TCC.
These results deserve a pause. The authors suggest PSC may win because it is easier to apply correctly every time and — critically — it allows clinicians to inspect and treat the wound at each visit without dismantling and rebuilding the cast. That matters enormously: wounds that can’t be seen can’t be managed. Limitations are real: this is a single-centre trial from one hospital system, conducted in a subtropical climate where patient demographics and walking habits differ from a Canadian urban clinic. Wagner grade 2 and 3 ulcers are also moderately severe, so results may not translate to very deep or infected ulcers. Larger multi-centre trials are needed before PSC is declared the new standard. Still, for clinicians frustrated by TCC’s poor real-world uptake, this study opens a practical door worth walking through.
📌 Source: Goyal G, Bose UB, Srivastava R, Majumder S, Mukherjee JJ, Jude EB. Comparison of posterior slab cast with total contact cast in the management of diabetic foot ulcers: A randomized controlled trial. Diabetes Res Clin Pract. 2026;234:113157. https://doi.org/10.1016/j.diabres.2026.113157 | PubMed PMID: 41692325
Tags: diabetic foot ulcer, offloading, total contact cast, posterior slab cast, neuropathic ulcer, wound healing, randomized controlled trial
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