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.

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)

Contralateral Peak Plantar Pressures with a Postoperative Boot

2011 ◽  
Vol 101 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Jamie N. Mieras ◽  
Tanya J. Singleton ◽  
Stephen L. Barrett
Keyword(s):  
Structural Properties ◽  
Plantar Pressure ◽  
Limb Length Discrepancy ◽  
Pressure Reduction ◽  
Length Discrepancy ◽  
Patient Complaints ◽  
Plantar Pressures ◽  
Frequent Use ◽  
Significant Difference ◽  
Better Than

Background: Frequent use of walking boots in podiatric medicine often elicits patient complaints and sequelae from the imposed limb-length discrepancy. This study was designed primarily to determine whether peak plantar pressures are decreased in the contralateral foot when a moderately worn athletic shoe is worn opposite a high-calf walking boot and, if so, secondarily to determine whether a specialized surgical shoe worn on the contralateral foot can also effectively reduce this pressure. The pressure reductions were then compared to determine whether significantly greater plantar pressure reduction was provided by either the athletic shoe or the surgical shoe. Methods: Participants without a foot abnormality walked on a treadmill in four footwear combinations: barefoot bilaterally, high-calf rocker-bottom sole (HCRB) walking boot/ barefoot, HCRB walking boot/athletic shoe, and HCRB walking boot/modified walking boot shoe. Measurements were taken with the participants wearing socks. Peak plantar calcaneal pressures were collected. Results: Peak plantar pressures under the calcaneus opposite the HCRB walking boot were significantly reduced from barefoot pressures when either an athletic shoe or the modified walking boot shoe was worn. However, no significant difference was seen when comparing the reduction by the athletic shoe with that by the modified walking boot. Conclusions: Wearing an athletic shoe on the foot opposite an HCRB walking boot reduces calcaneal pressures; however, wearing a modified device with structural properties of an HCRB walking boot sole is no better than an athletic shoe at reducing peak calcaneal pressures. (J Am Podiatr Med Assoc 101(2): 127–132, 2011)

Can the Use of a Terminal Device Augment Plantar Pressure Reduction with a Total Contact Cast?

2003 ◽  
Vol 24 (6) ◽  
pp. 500-505 ◽  
Author(s):  
Raja Dhalla ◽  
Jeffrey E. Johnson ◽  
Jack Engsberg
Keyword(s):  
Plantar Pressure ◽  
Healthy Adult ◽  
Statistical Significance ◽  
The Novel ◽  
Pressure Reduction ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Treatment Standard ◽  
The Right ◽  
Adult Volunteers

Hypotheses/Purpose: Total contact casting (TCC) has been shown to promote the healing of plantar neurotrophic ulcers by reducing plantar pressures and has become the established treatment standard by which all others are measured. The purpose of this study was to determine if terminal cast devices (cast shoes and heels) significantly affect the amount of plantar pressure reduction when used with a total contact cast. Methods/Results: Plantar pressures were measured in the right feet of 28 healthy adult volunteers using the Novel EMED PEDAR system (Novel GmbH, Munich, Germany) for six conditions: athletic shoe (i.e., control), TCC alone, TCC with a conventional cast shoe (EBI, Parsipanny, NJ), TCC with a custom rigid rocker cast shoe (NPS, St. Louis, MO), TCC with a rubber rocker heel (Cast Walker, DM Systems Inc., Evanston, IL), and TCC with a traditional flat rubber heel (Zimmer, Warsaw, IN). Peak plantar pressures were recorded from the forefoot, midfoot, and hindfoot. Analysis of variance (ANOVA) was used to determine statistical significance. The greatest reductions in forefoot plantar pressures compared to the athletic shoe control were seen in the TCC with the conventional cast shoe and the TCC with the rigid rocker shoe; a mean plantar pressure reduction of 30% was observed for both conditions ( p <.001). Significant midfoot plantar pressure reductions ( p <.001) were achieved with the TCC alone, TCC with the conventional cast shoe, TCC with the rigid rocker heel, TCC with the flat rubber heel, and TCC with the rubber rocker heel. Mean reductions were 42%, 51%, 47%, 40%, and 46%, respectively. While athletic shoe peak hindfoot pressures were only reduced by 15% by TCC alone, the addition of the rubber rocker heel to TCC reduced athletic shoe pressures by 32% and the addition of the flat rubber heel to TCC reduced athletic shoe pressures by 29%. The reductions with TCC and the heels were both significant when using the athletic shoe as the control ( p <.001) and the TCC alone as the control ( p <.05). Conclusion: Plantar pressure reduction with TCC can be augmented with the addition of a terminal cast device and the effects shown in this study are significantly different than previously reported. These results suggest that terminal cast devices should be chosen according to location of the neuropathic ulcer. In this study, forefoot pressures were reduced the most with TCC and either the conventional cast shoe or the rigid rocker shoe. The authors therefore recommend these combinations for forefoot ulcers. TCC alone or combined with any of the terminal devices proved equally effective for midfoot plantar pressure reduction. Hindfoot ulcers should be treated with TCC and the rubber rocker heel or the flat rubber heel as these provided the best hindfoot pressure reductions.

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.

Effect of Neutral-Cushioned Running Shoes on Plantar Pressure Loading and Comfort in Athletes with Cavus Feet

2008 ◽  
Vol 36 (11) ◽  
pp. 2139-2146 ◽  
Author(s):  
Caleb Wegener ◽  
Joshua Burns ◽  
Stefania Penkala ◽  
Grad Dip Ex Spr Sc
Keyword(s):  
Plantar Pressure ◽  
Regional Differences ◽  
Peak Pressure ◽  
Pressure Loading ◽  
Analog Scale ◽  
Reduced Pressure ◽  
Injury Rates ◽  
Plantar Pressures ◽  
Pressure Time ◽  
Running Shoes

Background High injury rates observed in athletes with cavus feet are thought to be associated with elevated plantar pressure loading. Neutral-cushioned running shoes are often recommended to manage and prevent such injuries. Purpose To investigate in-shoe plantar pressure loading and comfort during running in 2 popular neutral-cushioned running shoes recommended for athletes with cavus feet. Study Design Controlled laboratory study. Methods Plantar pressures were collected using the in-shoe Novel Pedar-X system during overground running in 22 athletes with cavus feet in 2 neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control condition (Dunlop Volley). Comfort was measured using a validated visual analog scale. Results Compared with the control, both neutral-cushioned running shoes significantly reduced peak pressure and pressure-time integrals by 17% to 33% ( P < .001). The Brooks Glycerin most effectively reduced pressure beneath the whole foot and forefoot ( P < .01), and the Asics Nimbus most effectively reduced rearfoot pressure ( P < .01). Both neutral-cushioned running shoes reduced force at the forefoot by 6% and increased it at the midfoot by 12% to 17% ( P < .05). Contact time and area increased in both neutral-cushioned running shoes ( P < .01). The Asics Nimbus was the most comfortable, although both neutral-cushioned running shoes were significantly more comfortable than the control ( P < .001). Conclusion Two popular types of neutral-cushioned running shoes were effective at reducing plantar pressures in athletes with cavus feet. Clinical Relevance Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure.

Assessment of Plantar Pressure in Hindfoot Relief Shoes of Different Designs

2014 ◽  
Vol 104 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Thomas Hahn ◽  
Hans-Dieter Carl ◽  
Andreas Jendrissek ◽  
Matthias Brem ◽  
Bernd Swoboda ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
The Other ◽  
Pressure Reduction ◽  
Normal Gait ◽  
Peak Pressures

Background Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes. Methods Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%–15% of total insole length), hindfoot (16%–30%), midfoot (31%–60%), and forefoot (61%–100%). Results Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P &lt; .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P &gt; .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline). Conclusions Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.

A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy

2020 ◽  
pp. 153473462091444
Author(s):  
Ali Ersen ◽  
Lawrence A. Lavery ◽  
Aakshita Monga ◽  
Mike Richardson ◽  
Brandy Schwarz ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Gait Speed ◽  
Peak Pressure ◽  
Casting Process ◽  
Clinical Effectiveness ◽  
Care Providers ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Cohen’S D ◽  
Cohen's D

The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen’s d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen’s d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

A Comparison of the Dynamic Pedobarograph and EMED Systems for Measuring Dynamic Foot Pressures

1995 ◽  
Vol 16 (9) ◽  
pp. 562-566 ◽  
Author(s):  
Barbara Quaney ◽  
Katja Meyer ◽  
Mark W. Cornwall ◽  
Thomas G. McPoil
Keyword(s):  
Data Collection ◽  
Peak Pressure ◽  
Peak Force ◽  
The Other ◽  
Vertical Force ◽  
Plantar Pressures ◽  
Other Hand ◽  
Assessment Systems ◽  
Peak Pressures

The purpose of this study was to compare the peak pressure and peak force values obtained from two pressure assessment systems, the Dynamic Pedobarograph and the EMED SF. Twenty-one individuals with a mean age of 31.6 years walked barefoot over both systems using a two-step data collection protocol. Peak plantar pressures and peak vertical force values were measured under the heel, central forefoot, hallux, and entire foot for both systems. The results of this study demonstrated that the EMED SF system produced larger peak pressures under the central forefoot and hallux. The Pedobarograph, on the other hand, produced greater pressures under the heel and entire foot. With respect to peak vertical forces, the Pedobarograph showed significantly greater values under the heel and central forefoot compared with the EMED SF, but were significantly lower under the hallux and entire foot.

A Comparison Study of Plantar Foot Pressure in a Standardized Shoe, Total Contact Cast, and Prefabricated Pneumatic Walking Brace

1997 ◽  
Vol 18 (1) ◽  
pp. 26-33 ◽  
Author(s):  
J.F. Baumhauer ◽  
R. Wervey ◽  
J. McWilliams ◽  
G.F. Harris ◽  
M.J. Shereff
Keyword(s):  
Peak Pressure ◽  
Foot Pressure ◽  
Total Contact Cast ◽  
Recommended Treatment ◽  
Time Integral ◽  
Custom Made ◽  
Plantar Ulcers ◽  
Total Contact Casting ◽  
Peak Pressures ◽  
Sensor Locations

Total contact casting is the current recommended treatment for Wagner Stage 1 and 2 neuropathic plantar ulcers. The rationale for this treatment includes the equalization of plantar foot pressures and generalized unweighting of the foot through a total contact fit at the calf. Total contact casting requires meticulous technique and multiple cast applications to avoid complications before ulcer healing. An alternative to total contact casting is the use of a prefabricated brace designed to maintain a total contact fit. This study compares plantar foot pressure metrics in a standardized shoe (SS), total contact cast (TCC), and prefabricated pneumatic walking brace (PPWB). Five plantar foot sensors (Interlink Electronics, Santa Barbara, CA) were placed at the first, third, and fifth metatarsal heads, fifth metatarsal base, and midplantar heel of 10 healthy male subjects. Each subject walked at a constant speed over a distance of 280 meters in a SS, PPWB, and TCC. A custom-made portable microprocessor-based system, with demonstrated accuracy and reliability, was used to acquire the data. No significant differences in peak pressure or contact duration were found between the initial and repeat SS trials ( P > 0.05). Peak pressures were reduced in the PPWB as compared to the SS for all sensor locations ( P < 0.05). Similarly, peak pressures were reduced in the TCC compared to the SS for all sensor locations ( P < 0.05) with the exception of the fifth metatarsal base ( P = 0.45). Our results are summarized as follows: (1) the methods used in the current study were found to be reliable through a test-retest analysis; (2) the PPWB decreased peak plantar foot pressures to an equal or greater degree than the TCC in all tested locations of the forefoot, midfoot, and hindfoot; (3) compared to a SS, contact durations were increased in both the TCC and PPWB for most sensor locations; and (4) the relationship of peak pressure over time, the pressure-time integral, is lower in the brace compared to the shoe at the majority of sensor locations. The values are not significantly different between the cast and shoe. These findings suggest an unweighting of the plantar foot and equalization of plantar foot pressures with both the PPWB and TCC. Based on these findings, the PPWB may be useful in the treatment of neuropathic plantar ulcerations of the foot.

Effect of Shoe Flexibility on Plantar Loading in Children Learning to Walk

2013 ◽  
Vol 103 (4) ◽  
pp. 297-305 ◽  
Author(s):  
Howard J. Hillstrom ◽  
Melanie A. Buckland ◽  
Corinne M. Slevin ◽  
Jocelyn F. Hafer ◽  
Leon M. Root ◽  
...  
Keyword(s):  
Peak Pressure ◽  
Structural Characteristics ◽  
Testing Machine ◽  
Structural Testing ◽  
Angular Rotation ◽  
Plantar Pressures ◽  
Plantar Pressure Distribution ◽  
Independent Ambulation ◽  
Walking Speeds ◽  
Peak Pressures

Background: In a previous pilot study of “cruisers” (nonindependent ambulation), “early walkers” (independent ambulation for 0–5 months), and “experienced walkers” (independent ambulation for 6–12 months), developmental age significantly affected the children’s stability when walking and performing functional activities. We sought to examine how shoe structural characteristics affect plantar pressure distribution in early walkers. Methods: Torsional flexibility was evaluated in four shoe designs (UltraFlex, MedFlex, LowFlex, and Stiff based on decreasing relative flexibility) with a structural testing machine. Plantar pressures were recorded in 25 early walkers while barefoot and shod at self-selected walking speeds. Peak pressure was calculated over ten masked regions for the barefoot and shod conditions. Results: Torsional flexibility, the angular rotation divided by the applied moment about the long axis of the shoe, was different across the four shoe designs. As expected, UltraFlex was the most flexible and Stiff was the least flexible. As applied moment increased, torsional flexibility decreased in all footwear. When evaluating early walkers during gait, peak pressure was significantly different across shoe conditions for all of the masked regions. The stiffest shoe had the lowest peak pressures and the most flexible shoe had the highest. Conclusions: It is likely that increased shoe flexibility promoted greater plantar loading. Plantar pressures while wearing the most flexible shoe are similar to those while barefoot. This mechanical feedback may enhance proprioception, which is a desirable attribute for children learning to walk. (J Am Podiatr Med Assoc 103(4): 297–305, 2013)

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