The first randomized clinical trial on different modes of off-load diabetic foot wounds by Armstrong et al. (1) was long awaited. The total contact cast (TCC) turned out to be better than a removable cast walker (RCW) or a half-shoe for the off-loading of neuorpathic plantar ulcers that were not “on the heel, rear foot, or area other than the plantar aspect of the foot” (1).

Unfortunately, the authors failed to indicate whether the type of half-shoe (Darco, Huntington, WV) used was one with extended “support surface all the way under the foot [… ]. [S]uch a shoe does not relieve the forefoot completely [… ] and should not be confused” (2) with a true half-shoe, according to Barouk (2,3,4). Forefoot plantar ulcers will be completely off-loaded with a Barouk-type half-shoe (Ipos, Niagara Falls, NY) but probably not with a Darco half-shoe.

1
Armstrong DG, Nguyen HC, Lavery LA, van Schie CHM, Goulton AJM, Harlkess LB: Off-loading the diabetic foot wound: a randomized clinical trial.
Diabetes Care
 
24
:
1019
–1022,
2001
2
Cavanagh PR, Ulbrecht JS, Caputo GM: New developments in the biomechanics of the diabetic foot.
Diabetes Metab Res Rev
 
16(Suppl. 1)
:
S6
–S10,
2000
3
Chantelau E, Breuer U, Leisch A, Tanudjaja T, Reuter M: Outpatient treatment of unilateral diabetic foot ulcers with “half shoes”.
Diabet Med
 
10
:
267
–270,
1992
4
Needleman RL: Successes and pitfalls in the healing of neuropathic forefoot ulcerations with the IPOS postoperative shoe.
Foot Ankle Int
 
18
:
412
–417,
1997

Address correspondence to Ernst Chantelau, Heinrich-Heine Universitat, Dusseldorf, Diabetes-Fuss-Ambulanz MNR-Klinik, Postfach 10 10 07, Dusseldorf D-40001, Germany.

2001