I just read the last foot notes written by Robert Frykberg, and I want to comment from my experiences with treating DFU.
Dear Robert, I think you forgot one important item: patient's compliance. Our treatment can be superb if the patient doesn't accept our advice we're nowhere.
I'm not a great admirer of the TCC for the following reasons:
2. much experience in application of a cast
3. only for Wagner 1 and 2 type of ulcers
4. not suitable with ischaemie or osteomyelitis
Therefore I've chosen the irremovable cast walker, and then not with an inlay as shown in fig. 3 (the Royce Medical device) with the removable plugs. I got very bad results with this type of inlay. Our orthotist makes a total contact inlay for each foot specific. Furthermore we only us the Aircast diabetic walker.
It is not my intention to step on anyone's foot, I only hope to start an discussion concerning a problem we're faced with, which is spreading like a virus.
With regards, I hope I didn't made to many languages errors.
Alex Bots (Belgium)