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Evidence to Improve Care

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers



Ontario Health Technology Advisory Committee Recommendation

  • The Ontario Health Technology Advisory Committee (OHTAC) recommends that fibreglass total contact casting, removable cast walkers, and irremovable cast walkers be publicly funded in patients presenting with a neuropathic diabetic plantar foot ulcer.

Read the full OHTAC Recommendation report


Diabetes can lead to nerve damage in the foot, causing the wasting of muscle and a loss of feeling. This, combined with increased pressure from shoes, a foot deformity or trauma to the foot, contributes to the development of foot ulcers. Foot ulcers can lead to disease and put people at risk for amputation of the foot or leg.

Devices that reduce pressure in the foot, called "pressure offloading devices," are an important way to treat foot ulcers by removing the pressure points that lead to or exacerbate foot ulcers. These devices include: fibreglass total contact casting, removable cast walkers, and irremovable cast walkers.


Health Quality Ontario Reviews Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers

In Ontario in 2015, there were approximately 1.5 million people with diabetes. Estimates indicate that 2% to 3% of people with diabetes experience a foot ulcer each year. Devices that assist in reducing pressure improved ulcer healing. However, cost, comfort, and convenience are concerns for patients.

The 5-year budget impact of fully funding total contact casting, removable cast walkers, and irremovable cast walkers would be $17 to $20 million per year. However, the health system would be expected to save money because fewer people would need amputations.


Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment
September 2017


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The Ministry of Health and Long-Term Care is currently reviewing this recommendation.



Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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