Total Contact Casting

2019 ◽  
pp. 77-88
Author(s):  
Maureen Bates ◽  
Timothy Jemmott ◽  
Michael E. Edmonds
Keyword(s):  
Total Contact Casting

Pneumatic Bracing and Total Contact Casting Have Equivocal Effects on Plantar Pressure Relief

2001 ◽  
Vol 22 (6) ◽  
pp. 502-506 ◽  
Author(s):  
Heather D. Hartsell ◽  
Chris Fellner ◽  
Charles L. Saltzman
Keyword(s):  
Plantar Pressure ◽  
Pressure Relief ◽  
Total Contact Casting

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.

Total contact casting

1995 ◽  
Vol 85 (3) ◽  
pp. 172-176 ◽  
Author(s):  
RE Baker
Keyword(s):  
Effective Treatment ◽  
Diabetic Foot ◽  
Treatment Modality ◽  
Treatment Method ◽  
Complex Treatment ◽  
Effective Treatment Modality ◽  
Total Contact Casting ◽  
Neuropathic Foot

The treatment of diabetic foot ulcerations has been a difficult task for podiatrists. Numerous methods and materials have been used in an attempt to alleviate this frustrating and complex treatment dilemma. However, there is one treatment method that has been used successfully for decades on plantar ulcerations of the neuropathic foot. Total contact casting has been an easily applicable and effective treatment modality for neuropathic ulcerations of the diabetic foot.

scholarly journals Foot Ulcers: A Different Technique to Total Contact Casting for Healing Chronic Foot Ulcers

2017 ◽  
Vol 2 (4) ◽  
Keyword(s):  
Standard Method ◽  
Gold Standard ◽  
Foot Ulcers ◽  
Evidence Based ◽  
Diabetic Foot Ulcers ◽  
Patient Mobility ◽  
Gold Standard Method ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Total Contact Casting

Total Contact Cast (TCC) is considered the gold standard method for healing diabetic foot ulcers (DFU) [1]. Chronic foot ulcers are a growing concern worldwide. Evidence-based research suggests that TCC is the best method to offload the plantar foot by adequately redistributing plantar pressures related to body mass while still maintaining patient mobility.

scholarly journals Prevalence of Symptomatic Venous Thrombo-Embolism in Patients with Total Contact Cast for Diabetic foot Complications; A Retrospective Case Series

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Roland King ◽  
Simon Platt ◽  
Gillian Jackson
Keyword(s):  
Retrospective Review ◽  
Diabetic Foot ◽  
Case Series ◽  
Time Frame ◽  
High Rate ◽  
Diabetic Patients ◽  
Retrospective Case ◽  
Total Contact Cast ◽  
Prolonged Contact ◽  
Total Contact Casting

Category: Ankle, Diabetes, Midfoot/Forefoot Introduction/Purpose: Venous thrombo-embolism (VTE) is a costly and potentially life threatening complication of limb immobilisation in a plaster of Paris cast. It is now generally recommended that patients undergoing limb immobilisation in cast are given LMWH therapy. The gold standard of treatment for diabetic patients with Charcot feet is total contact casting (TCC). TCC is also employed in the management of diabetic foot ulceration (DFI). Such casting is often prolonged with a time frame greater than 6 weeks. In general diabetic patients with established complication, (Charcot, DFI) often have comorbidities which increase the risk of VTE when the limb is immobilised. One would anticipate these patients to have a high rate of VTE given the immobile limb and comorbidities contributing to higher risk. Methods: A retrospective review was undertaken. A search on patients’ records up to April 2015 was undertaken to identify patients placed into total contact casting. These patients all had DFI or Charcot treated with a TCC. The patient’s electronic and paper records were reviewed for any documentation of VTE, as well as other co-morbidities. Results: 18 patients aged between 43 and 78 (mean 60) were identified. These patients were casted between one week to 3 months. None of these 18 patients sustained a documented VTE. None of them were on prophylactic anti-coagulation for the time they were in cast. All of the patients had a documented significant cardiovascular history (as well as Diabetes Mellitus), with HbA1c values ranging from 45 to 122 (median 74). Body mass index values for all of the patients were unavailable. Conclusion: Despite high risk for the developing a VTE, none of the patients in our series suffered a documented symptomatic PE or DVT. We recognise the limitations of our study; small numbers with retrospective review. Nonetheless, we hypothesised that with prolonged contact casting in patients with significant comorbidity the prevalence of VTE would be higher than that observed. We believe that this is the first study looking for VTE in a TCC and diabetic population.

scholarly journals Use of Computed Tomography and Plantar Pressure Measurement for Management of Neuropathic Ulcers in Patients With Diabetes

1999 ◽  
Vol 79 (3) ◽  
pp. 296-307 ◽  
Author(s):  
Michael J Mueller ◽  
Kirk E Smith ◽  
Paul K Commean ◽  
Douglas D Robertson ◽  
Jeffrey E Johnson
Keyword(s):  
Computed Tomography ◽  
Pressure Measurement ◽  
Plantar Pressure ◽  
Ulcer Recurrence ◽  
X Ray ◽  
Plantar Pressures ◽  
X Ray Computed ◽  
Plantar Pressure Measurement ◽  
Total Contact Casting ◽  
Neuropathic Ulcers

AbstractBackground and Purpose. Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%–57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. Case Description. The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. Outcomes. The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. Discussion. Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.

scholarly journals Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Danielle A. Griffiths ◽  
Michelle R. Kaminski
Keyword(s):  
Traumatic Injury ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Joint Disease ◽  
Asia Pacific ◽  
Foot And Ankle ◽  
Charcot Foot ◽  
Charcot Neuroarthropathy ◽  
Inflammatory Phase ◽  
Total Contact Casting

Abstract Background Charcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this study aimed to address these deficiencies. Methods This study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher’s exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated. Results Mean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants. Conclusions The median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.

Efficacy of Intra-Lesional Platelet Rich Plasma in Diabetic Foot Ulcer

2020 ◽  
Author(s):  
Ajay Gupta ◽  
Chethan Channaveera ◽  
Satyaranjan Sethi ◽  
Sunil Ranga ◽  
Vijender Anand
Keyword(s):  
Normal Saline ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Platelet Rich Plasma ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Control Group ◽  
Study Group ◽  
Ulcer Area ◽  
Total Contact Casting

Background: Diabetic foot ulcer (DFU) is well managed by infection control, euglycemic state, debridement of ulcer followed by appropriate dressing and off-loading of the foot. Studies have reported that when DFU is properly off-loaded, about 90% of these would heal in nearly six weeks. Platelet rich plasma (PRP) serves as a growth factor agonist and has mitogenic and chemotactic properties which help in DFU healing. To evaluate the efficacy of local application of PRP with respect to healing rate and ulcer area reduction in treating diabetic foot ulcer. Materials and Methods: Sixty non-infected DFU patients with plantar ulcer of size less than 20cm2 and Wagner's Grade 1 & 2 were randomized to receive normal saline dressing (Control group - CG) or PRP dressing (Study group - SG) in conjunction with total contact casting for 6 weeks (or till complete ulcer healing), whichever was earlier. Evaluation was done at weekly interval for healing rate and change in ulcer area.Results: Mean ulcer area of study participants at baseline was 4.96 {plus minus} 2.89cm2 (CG) and 5.22 {plus minus} 3.82cm2 (SG) (p=0.77) which decreased to 1.15{plus minus}1.35cm2 (CG) and 0.96{plus minus}1.53cm2 (SG) (p=0.432) at 6wks. Percent reduction in mean healing area at 6wks was 81.72{plus minus}17.2% and 85.98{plus minus}13.42% in control group and study group respectively (p=0.29). Average rate of healing achieved at 6 weeks was 0.64{plus minus}0.36cm2 and 0.71{plus minus}0.46cm2 in control group and study group respectively (p=0.734). Conclusions: PRP dressing is no more efficacious than normal saline dressing in management of DFU in conjunction with total contact casting.

scholarly journals Total Contact Casting for Diabetic Neuropathic Ulcers

1996 ◽  
Vol 76 (3) ◽  
pp. 296-301 ◽  
Author(s):  
David R Sinacore
Keyword(s):  
Total Contact Casting ◽  
Neuropathic Ulcers
Sign in / Sign up

Export Citation Format

Share Document