Application of a Total Contact Cast

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Admin2 · Jun 29, 2008

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NewsBot · Oct 3, 2008

A comparative study between total contact casting and conventional dressings in the non-surgical management of diabetic plantar foot ulcers.
Ganguly S, Chakraborty K, Mandal PK, Ballav A, Choudhury S, Bagchi S, Mukherjee S.
J Indian Med Assoc. 2008 Apr;106(4):237-9, 244.

Of all non-traumatic amputations 50% occur in Diabetics, mostly as a final outcome of foot ulcers. A major biomechanical factor in the causation of foot ulcers in persons with diabetes mellitus is elevated peak plantar pressure. Offloading the ulcer area in the form of equalisation of pressure across the plantar surface can accelerate healing of the ulcer. Total contact casting is one such method of offloading, and this study attempts to investigate the advantages of the above method as compared to conventional dressings in the physiatric management of the depth--ischaemia grades 1A, 1B, 2A, 2B neuropathic plantar ulcers in a diabetic patient. The outcome measure was the time taken for complete resolution of the ulcers. Of the 29 patients in Category A treated with total contact casting involving a total of 39 foot ulcers, 36 healed, which was statistically significant (p < 0.05) as compared to 25 out of the 33 ulcers healing in Category B consisting of 26 patients treated by conventional dressings alone. Total contact casting is an effective, rapid, economical, ambulatory and outpatient--based method for the treatment of diabetic foot ulcers
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NewsBot · Jan 23, 2009

Total contact cast for neuropathic diabetic foot ulcers.
Ali R, Qureshi A, Yaqoob MY, Shakil M.
J Coll Physicians Surg Pak. 2008 Nov;18(11):695-8.

OBJECTIVE: To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast (TCC) in terms of percentage of ulcers healed and time to heal. Study Design: Analytical study.

PLACE AND DURATION OF STUDY: Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, from April 2005 to March 2007.

METHODOLOGY: The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast (TCC) was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast.

RESULTS: Thirty four (87.17%) patients were males and 5(12.82%) were females. The mean age was 62 +/- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41(78.84%) healed with TCC in an average 2 casts duration (mean 32 days). There were 11(21.15%) cast failure. Majority (63.63%) of cast failure ulcers were located on pressure bearing area of heel. Most (90%) of the ulcers on forefoot and midsole region healed with TCC (p < 0.001). Longer ulcer duration (mean 57.45 +/- 29.64 days) significantly reduced ulcer healing (p < 0.001).

CONCLUSION: Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region.
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