New Casting Techniques: Introduction to the ‘Instant Total Contact Cast’

2006 ◽  
pp. 250-254
Author(s):  
David G. Armstrong ◽  
Stephanie C. Wu ◽  
Ryan C. Crews
Keyword(s):  
Total Contact Cast

Is TCC-EZ a Suitable Alternative to Gold Standard Total-Contact Casting?

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Umangi K. Bhatt ◽  
Hui Ying Foo ◽  
Mahalia P. McEvoy ◽  
Sarah J. Tomlinson ◽  
Cara Westphal ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peak Pressure ◽  
Pressure Reduction ◽  
Reduced Pressure ◽  
Suitable Alternative ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Signed Rank ◽  
Significant Difference ◽  
Peak Pressures

Background The total-contact cast (TCC) is the gold standard for off-loading diabetic foot ulcers (DFUs) given its nonremovable nature. However, this modality remains underused in clinical settings due to the time and experience required for appropriate application. The TCC-EZ is an alternative off-loading modality marketed as being nonremovable and having faster and easier application. This study aims to investigate the potential of the TCC-EZ to reduce foot plantar pressures. Methods Twelve healthy participants (six males, six females) were fitted with a removable cast walker, TCC, TCC-EZ, and TCC-EZ with accompanying brace removed. These off-loading modalities were tested against a control. Pedar-X technology measured peak plantar pressures in each condition. Statistical analysis of four regions of the foot (rearfoot, midfoot, forefoot, and hallux) was conducted with Friedman and Wilcoxon signed rank tests. Significance was set at P < .05. Results All of the off-loading conditions significantly reduced pressure compared with the control, except the TCC-EZ without the brace in the hallux region. There was no statistically significant difference between TCC-EZ and TCC peak pressure in any foot region. The TCC-EZ without the brace obtained significantly higher peak pressures than with the brace. The removable cast walker produced similar peak pressure reduction in the midfoot and forefoot but significantly higher peak pressures in the rearfoot and hallux. Conclusions The TCC-EZ is a viable alternative to the TCC. However, removal of the TCC-EZ brace results in minimal plantar pressure reduction, which might limit clinical applications of the TCC-EZ.

Arthrodesis and the Total-Contact Cast in Treatment of the Neuropathic Foot

2001 ◽  
Vol 83 (9) ◽  
pp. 1437-1438
Author(s):  
Sheldon R. Simon ◽  
Samir G. Tejwani ◽  
Deborah L. Wilson ◽  
Thomas J. Santner ◽  
Nancy L. Denniston
Keyword(s):  
Total Contact Cast ◽  
Neuropathic Foot

scholarly journals Risk of Complications with the Total Contact Cast in Diabetic Foot Disorders

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Alexandria Riopelle ◽  
Ryan LeDuc ◽  
Michael S. Pinzur ◽  
Adam P. Schiff
Keyword(s):  
Diabetic Foot ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Treatment Algorithm ◽  
Retrospective Chart Review ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Charcot Foot ◽  
Total Contact Cast ◽  
Definition Of

Category: Diabetes Introduction/Purpose: The total contact cast is an important component of the clinical treatment algorithm for diabetic foot ulcers and Charcot Foot Arthropathy. Few studies have reported on the complications associated with this treatment modality. Methods: Over a ten year period, 2265 total contact casts were placed on 384 patients during their treatment for diabetic foot disorders. All of the casts were applied by a Certified Orthopaedic Technologist under the supervision of a University Faculty member. Complications were grouped as: (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change / removal. Complications were then associated with Hemoglobin A1C levels at the time of treatment. Results: Using this very stringent definition of a complication, ten percent of patients had some form of a complication. Most complications resolved following cast change or cast removal. Conclusion: The total contact cast has been demonstrated to be a valuable tool in the treatment of diabetic foot disorders. This retrospective chart review should serve as a valuable reference to assist clinicians when counseling patients during treatment for diabetic foot disorders.

Evaluating Iatrogenic Complications of the Total-Contact Cast

2016 ◽  
Vol 106 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Tammy M. Owings ◽  
Nicole Nicolosi ◽  
Jessica M. Suba ◽  
Georgeanne Botek
Keyword(s):  
Cleveland Clinic ◽  
Ulcer Formation ◽  
Total Contact Cast ◽  
Iatrogenic Complications ◽  
Study Support ◽  
Total Contact Casting ◽  
Lost To Follow Up ◽  
Neuropathic Foot ◽  
Partial Foot Amputation

Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications. Methods: The largest retrospective review to date of iatrogenic complications of total-contact casts was conducted over an 8-year period at Cleveland Clinic. Results: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation. Of these complications, 92.1% resolved, 6.4% were lost to follow-up, and 1.4% resulted in a partial foot amputation. Mean cast duration was 10.3 days for patients who developed a total-contact cast iatrogenic complication. The most common indication for the use of a total-contact cast was a neuropathic foot ulceration. Conclusions: The results of this study support the use of total-contact casting in the insensate patient with diabetes. However, adequate staff training in total-contact cast application is recommended to reduce complications.

Plantar Pressures in Fiberglass Total Contact Casts vs. a New Diabetic Walking Boot

2003 ◽  
Vol 24 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Fabian E. Pollo ◽  
James W. Brodsky ◽  
Stephanie J. Crenshaw ◽  
Chris Kirksey
Keyword(s):  
Measurement System ◽  
Normal Subjects ◽  
Foot Deformities ◽  
The Novel ◽  
Healthy Individuals ◽  
Plantar Surface ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Pressure Measurement System ◽  
Better Than

The objective of this study was to determine in healthy individuals whether the Bledsoe Diabetic Conformer Boot reduces plantar pressures as well as a fiberglass total contact cast. Eighteen normal subjects, without any prior foot or ankle problems, were recruited for this study. Plantar pressures were measured using the Novel Pedar™ in-shoe pressure measurement system. The results of this study demonstrate that in individuals without foot deformities, the Bledsoe Diabetic Conformer Boot™ performs as well as, and in many parameters, even better than a fiberglass total contact cast with respect to reducing the forces and pressures on the plantar surface of the foot.

Technique for Fabrication of an “Instant Total-Contact Cast” for Treatment of Neuropathic Diabetic Foot Ulcers

2002 ◽  
Vol 92 (7) ◽  
pp. 405-408 ◽  
Author(s):  
David G. Armstrong ◽  
Brian Short ◽  
Eric H. Espensen ◽  
Patricia L. Abu-Rumman ◽  
Brent P. Nixon ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Gold Standard ◽  
Simple Technique ◽  
Patient Adherence ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Pressure Reduction ◽  
Critical Component ◽  
Total Contact Cast ◽  
Equivalent Time

Addressing pressure reduction in the treatment of diabetic foot wounds is a critical component of therapy. The total-contact cast has proven to be the gold standard of treatment because of its ability to reduce pressure and facilitate patient adherence to the off-loading regimen. Removable cast walkers have proven to be as effective as total-contact casts in pressure reduction, but this has not translated into equivalent time to healing. A simple technique to convert the removable cast walker into a device that is not as easily detached from the lower extremity, thereby encouraging the use of this device over a 24-hour period, is presented in this article. The procedure involves wrapping the cast walker with cohesive bandage or plaster of Paris. In the authors’ opinion, this technique addresses many of the disadvantages of the total-contact cast, resulting in an adequate compromise in this aspect of care. (J Am Podiatr Med Assoc 92(7): 405-408, 2002)

The Mechanism of Plantar Unloading in Total Contact Casts: Implications for Design and Clinical Use

1997 ◽  
Vol 18 (12) ◽  
pp. 809-817 ◽  
Author(s):  
Jonathan E. Shaw ◽  
Wei-Li Hsi ◽  
Jan S. Ulbrecht ◽  
Arleen Norkitis ◽  
Mary B. Becker ◽  
...  
Keyword(s):  
Ground Reaction Force ◽  
Load Distribution ◽  
Reaction Force ◽  
Diabetic Patients ◽  
Clinical Use ◽  
Force Measurements ◽  
Bearing Surface ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Plantar Ulcers

Although the total contact cast (TCC) has been shown to be an extremely effective treatment for the healing of plantar ulcers in diabetic patients, little is known about the biomechanics of its action. In this study, plantar pressure and ground reaction force measurements were obtained from over 750 foot contacts as five subjects with known elevated plantar forefoot pressures walked barefoot, in a padded cast shoe, and a TCC. Peak plantar pressures in the forefoot were markedly reduced in the cast compared with both barefoot and shoe walking (reductions of 75% and 86% respectively, P < 0.05). Peak plantar pressures in the heel were not, however, significantly different between the shoe and the TCC, and the longer duration of heel loading resulted in an impulse that was more than twice as great in the cast compared with the shoe ( P < 0.05). An analysis of load distribution indicated that the mechanisms by which the TCC achieves forefoot unloading are (1) transfer of approximately 30% of the load from the leg directly to the cast wall, (2) greater proportionate load sharing by the heel, and (3) removal of a load-bearing surface from the metatarsal heads because of the “cavity” created by the soft foam covering the forefoot. These results point out some of the “essential design features” of the TCC (which are different from what had been previously supposed), support the use of the TCC for healing plantar ulcers in the forefoot, but raise questions about its utility in the healing of plantar ulcers on the heel.

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