Total contact casting

Total Contact Casting

Physical causes of diabetic foot ulcers

Examples of foot off-loading devices

Comparison of off-loading devices

Total contact casting (TCC) is a specialized treatment method used primarily for the management of diabetic foot ulcers. It involves the application of a cast that is molded to the contours of the foot and lower leg, distributing weight evenly and reducing pressure on the ulcerated area. This technique is considered the gold standard for off-loading pressure from the foot to promote healing.

History

The concept of total contact casting was first introduced in the 1930s by Dr. Paul Brand, who developed the technique to treat leprosy patients with foot ulcers. Over time, it has been adapted and refined for use in diabetic foot care.

Indications

Total contact casting is primarily indicated for patients with neuropathic foot ulcers, particularly those resulting from diabetes mellitus. It is most effective for non-infected, non-ischemic ulcers. The cast helps to off-load pressure from the ulcer site, allowing for improved healing conditions.

Procedure

The application of a total contact cast involves several steps:

1. Preparation: The foot is cleaned and any necrotic tissue is debrided. A protective layer is applied to bony prominences to prevent pressure sores. 2. Casting: A fiberglass or plaster cast is applied, molded closely to the foot and leg to ensure even distribution of pressure. 3. Follow-up: The cast is typically changed every 1-2 weeks to monitor the ulcer and adjust the fit as needed.

Advantages

- Pressure Redistribution: TCC effectively redistributes pressure away from the ulcer site, promoting healing. - Patient Compliance: The non-removable nature of the cast ensures consistent off-loading, improving treatment adherence.

Disadvantages

- Limited Mobility: Patients may experience reduced mobility, which can impact daily activities. - Risk of Complications: Improper application can lead to complications such as skin breakdown or infection.

Alternatives

While TCC is highly effective, other off-loading devices are available, including:

- Removable Cast Walkers: These allow for easier inspection and dressing changes. - Half-Shoes: Designed to off-load pressure from the forefoot. - Custom Orthotics: Tailored to redistribute pressure based on individual needs.

Related Pages

• Diabetic foot ulcer
• Off-loading (medical)
• Diabetes management

Total_contact_casting

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  Physical causes of diabetic foot ulcers

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  Examples of foot off-loading devices

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  Comparison of off-loading devices