Abstract
There are three basic principles in the management of diabetic foot ulcer (DFU) –adequate debridement and infection control, adequate vascularity, and adequate offloading. Off-loading of the ulcer area is extremely important for the healing of neuropathic plantar  ulcers. Total contact cast is the Gold standard among all offloading techniques, but there are some practical limitations with the use of  this modality.
Objective
This study was conducted to evaluate the efficacy of Modified Posterior slab ( posterior slab with Micro Cellular Rubber  insole with window at ulcer site)  with window walking  TCC in healing of  neuropathic planter diabetic foot ulcers in fore foot and mid foot.
Method:  Patients having non healing  neuropathic planter  diabetic foot ulcers  in fore foot and mid foot with  Wagner's classification Grade I-II were included in this study.
This is an open level observational study on non healing neuropathic planter  diabetic foot  ulcers. Total 60 subjects, attending the foot clinic with non healing neuropathic planter  diabetic foot ulcers were included in this study and divided into two groups comprising of 30 patients each.  Ulcers were debrided in both groups followed by off loading. 
The patients in group A  [male: 16 and female: 14] having average age 53.5 yrs [28-73], average HbA1C 9.77% [7 to 12.1], BMI 26.6 ( 20-35), average duration of diabetes 12.68 yrs ( 01 -38 months), average duration of DFU 13.52 months ( 01-60 months) were put on modified posterior slab. 
The patients in group B [male: 21 and female: 9] having average age 55yrs [38 to 73], average HbA1C 9.91% [5.8 to 14.2], BMI 26.8 [19 to 36 ], avareage duration of diabetes 14.4 yrs (02-40 yrs), average duration of DFU 17.53 months ( 01-72 months) were put on modified window walking TCC.
In both groups X- ray of foot, Ankle/Brachial Index (ABI)  were normal  and  monofilament and Vibration perception threshold were impaired.



Result:
In group A  with posterior slab, the average healing time was 12 weeks and in group B  with window walking TCC it was 11.2 weeks.There was no significant difference found in healing time. Though TCC is considered gold standard but modified posterior slab is also a good off-loading modality in healing of neuropathic planter  diabetic foot ulcers in forefoot and mid foot. It was observed that  modified posterior slab was more convenient, economical and most importantly more  acceptable mode of offloading in  comparison to window walking TCC. In modified posterior slab the whole foot could be observed along with the ulcer as compared to window walking TCC where only the ulcer could be observed. In both the offloading modalities, regular dressing of ulcer could be carried out by family members/caregivers.   
Conclusion:
•	This study comprehensively evaluated theadvantages and disadvantages of a  modified posterior slab and a window walking TCC in the treatment of diabetic neuropathic foot ulcer in fore foot  and mid foot.
•	Modified Posterior Slab is as useful and effective  as window walking TCC in healing of non healing neuropathic planter ulcers.
•	Modified posterior slab is more economical as single posterior slab can be used till complete healing of ulcer.

Comparative study of modified total contact cast and modified posterior slab in managing planter diabetic foot ulcers