Most diabetic ulcers are surrounded by a thick rim of keratinized tissue. This will impede healing if left untreated. All necrotic tissue should be removed from the wound bed. Enzymatic debriding agents or dressings intended to facilitate autolytic debridement can be used when sharp debridement is not an option. This below-knee cast limits excessive foot motion and redistributes the body's weight over the entire foot.
Patient compliance is improved because ambulation is permitted.
The TCC is heavily padded over all bony prominences to prevent further tissue injury. The TCC should be discontinued when reepithelialization occurs. Although a walking boot provides almost identical pressure relief to a TCC, it requires greater patient compliance. Crutches also can be used to off-load the foot. Plastazote or other soft insoles, soft-soled healing shoes, or modified postoperative shoes are of minimal benefit, although they may provide some pressure reduction.