Patients with diabetic foot ulcers who use removable cast walkers need more information to promote higher compliance and better healing, a study in the Journal of Wound Care finds.

In interviews, researchers discovered that patients often wore the off-loading devices less than 100% of the time, but more alarmingly, they often wore them much less than they initially reported to interviewers. Patients took the casts off indoors during sedentary activities but also revealed they’d done so while walking a short distance (such as to the toilet at night) or outdoors.

“Some participants believed that no harm could occur when not wearing the device for short distances and others believed that wearing [the device] for every step was not necessary,” researchers in Australia and Jordan reported. “This potentially reflected the misperception of what optimal (100%) adherence meant to participants.”

They found both wound pain and progression of wound healing motivated participants to adhere to wearing their casts. Engaging patients in those areas was seen as a promising way to enhance adherence.