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How much is better the total contact casting than a walker cast? In Spain we have two main problems with the walker cast, it´s expensive (about 300 euros) and the low adhesion to the treatment. I think that tcc is a good option for neuropathic wounds, not only for the cost, it has good results (vascular surgeons have been using it for years with success, by the way those cast were made of plaster...).
Thanks

 

We use a scotchcast TCC to good effect and use them as our 'gold standard' treatment (although i hate that phrase) - however some patients just cant get on with them and obviously the contra-indications that go with them.

We also use to the standard scotchcast boot but are now using the softcast slipper cast with some reasonable results at the moment. We also use aircasts and the machester heel cup for appropriate ulcerations.

In an ideal world everyone would have a TCC but it all depends on the patient infront of you.

 

Eviedence does not seem to show that, but the problem is walkers are not warn the same periodS as TCC -here - Effectiveness of Removable Walker Cast
Versus Nonremovable Fiberglass
Off-Bearing Cast in the Healing of Diabetic
Plantar Foot Ulcer



An Off-the-Shelf Instant Contact Casting
Device for the Management of Diabetic
Foot Ulcers

But removable cast walkers work better when made irremovable - http://www.diabeticmctoday.com/HtmlPages/DMC0505/PDFs/DMC_Armstrong.pdffull text found below


Diabetes: Options for Offloading

maybe something here - http://www.oaac.ca/2009present/Neuropathic%20foot-%20Reilly.pdf

But really I don´t deal with these patients - just waiting for some plastic to heat in the oven

Hope it helps some

 

Mike,

The reason why these papers are around is because it isnt an ideal world!

Some good references to the iTCC which does have very good use's and is definatley a help in areas - especially in places where not many people know how to TCC properly.

I think the key thing in all those papers, is that they are trying to get other therapies to be as good as the TCC, and whilst many of them show to be as effective in areas, the vast majority of patients will still find a way to get the walker off - it just seems to be the nature of a lot of these type of clients. Hence why we are not in an ideal world.

Thats why where possible i will TCC, but for people with a UoT score C/Ischamia, risk of rubs etc then walkers can work, as can slipper casts, scothcast boots...

You do wonder at times if they know we are actually trying to help them :drinks