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The total contact cast 'controversy'

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jan 4, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    The total contact cast: controversy in offloading the diabetic foot
    Sophie Whitelaw
    British Journal of Community Nursing, Vol. 17, Iss. 12 - Supp, 13 Dec 2012, pp S16 - S20
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

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    Press Release:
    Published Research Concludes Total Contact Casting is More Effective in Healing Diabetic Foot Ulcers Than Other Standards of Care
    Review of studies published in The Cochrane Collaboration
     
  4. NewsBot

    NewsBot The Admin that posts the news.

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  5. NewsBot

    NewsBot The Admin that posts the news.

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    Off-Loading Total Contact Cast in Combination with Hydrogel and Foam Dressing for Management of Diabetic Plantar Ulcer of the Foot
    Tanawat Vaseenon, Songwut Thitiboonsuwan, Chaiyarit Cheewawattanachai, Punngam Pimchoo, Areerak Phanphaisarn
    JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND, Vol 97, No 12
     
  6. NewsBot

    NewsBot The Admin that posts the news.

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    Off-loading total contact cast in combination with hydrogel and foam dressing for management of diabetic plantar ulcer of the foot.
    Vaseenon T, Thitiboonsuwan S, Cheewawattanachai C, Pimchoo P, Phanphaisarn A.
    J Med Assoc Thai. 2014 Dec;97(12):1319-24.
     
  7. NewsBot

    NewsBot The Admin that posts the news.

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    Evaluating Iatrogenic Complications of the Total-Contact Cast
    An 8-Year Retrospective Review at Cleveland Clinic

    Tammy M. Owings, Nicole Nicolosi, Jessica M. Suba, and Georgeanne Botek
    Journal of the American Podiatric Medical Association: January 2016, Vol. 106, No. 1, pp. 1-6.
     
  8. NewsBot

    NewsBot The Admin that posts the news.

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    Diabetic Foot Ulcers: The Importance of Patient Comorbidity Recognition and Total Contact Casting in Successful Wound Care.
    Jagadish M et al
    Am Surg. 2016 Aug;82(8):733-736.
     
  9. NewsBot

    NewsBot The Admin that posts the news.

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    Total Contact Cast System to Heal Diabetic Foot Ulcers.
    Liden B
    Surg Technol Int. 2017 Jul 11;30. pii: sti30/872
     
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    NewsBot The Admin that posts the news.

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    Outcomes Achieved With Use of a Prefabricated Roll-On Total Contact Cast
    Jonathan F. Arnold MD, ABPM-UHM, CWS-P, Valerie Marmolejo, DPM
    Foot & Ankle International August 11, 2017
     
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    Prevalence of Symptomatic Venous Thrombo-Embolism in Patients with Total Contact Cast for Diabetic foot Complications; A Retrospective Case Series
    Roland King, MBChB, Simon Platt, MB ChB, FRCS, Gillian Jackson, MB ChB
    Foot & Ankle Orthopaedics September 18, 2017
     
  12. NewsBot

    NewsBot The Admin that posts the news.

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    Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment.
    Ont Health Technol Assess Ser. 2017 Sep 21;17(12):1-124. eCollection 2017.
     
  13. Dr. Steven King

    Dr. Steven King Active Member

    Aloha,

    If TCC's have been made the "Gold" standard what heck are the standards for the silver and bronze modalities??

    "There is minimal robust evidence for the use of the TCC over other offloading modalities such as the removable cast walker and the instant total contact cast. However there is also minimal evidence for iatrogenic lesions caused by TCC. Additionally, the superior offloading properties and expedited healing rates of the TCC are demonstrated in a number of smaller studies. In conclusion there is a lack of consensus on the best device to offload DFU."

    I propose the following Platinum Standard.
    "Off loading gait devices must show significant and testable improvements in energy efficiency, gait stability reducing pressure and shear at high risk body areas while minimizing peak load impulses."


    If a big heavy clunky TCC works because it act as an earth anchor what have we really achieved?
    Perhaps the patients should just stay on the couch and forget about taking a nice cleansing shower or bath while wearing a non-removable cast ):


    The best system will allow the least imposition on life styles and gait abilities.

    We can and should do better.
    Steve
     
  14. Mart

    Mart Well-Known Member


    Steve

    What about the possibility that TCCs work primarily because they cannot be removed? If that is true then the value of or even need for the mechanically measurably best device (whatever that may be) is moot. Based on my own clinical experience and evidence from the study below study that's where I would put my money currently; if you are unfamiliar I have copy and pasted the conclusions from study below

    CONCLUSIONS— The results of this study suggest that patients with diabetic foot ulcerations wear their offloading devices for only a minority of the steps taken each day. To our knowledge, this is the first report in the medical literature evaluating the activity of subjects with wounds both in and out of their primary off-loading device. Over the past decade, there have been a number of large trials and analyses of wound healing agents designed for the treatment of diabetic foot wounds. These have included bioengineered tissues, recombinant growth factors, oxidized regenerated cellulose, and a host of physical modalities (8–16). Whereas all of these modalities have, to one degree or another, shown promise in treating segments of this population, the overall prevalence of healing has been disappointing. Although we were not surprised by the overall findings with this study, we were alarmed by the surprisingly high percentage of steps taken without adequate plantar protection. Nearly 75% of the steps taken per day in these patients were taken without adequate pressure relief. Because this is a novel methodology to assess adherence, we have tried to contemplate potential methodological reasons why this number could be as low as it is. Certainly, there may be built-in inaccuracies in the activity monitoring devices. However, all of these devices were tested for function accuracy by both the factory and our team both before and after the tests. If there were significant inaccuracies, we would presume that these would be more or less proportionately the same for all devices used and could not explain the enormous difference in readings. Furthermore, we were using the waist-worn device as a measure of total activity and the RCW-attached device as merely a measure of “active” or “not active.” Therefore, we cannot explain this difference based on the physical location of the device. In conclusion, it appears as though patients with neuropathic diabetic foot wounds do not wear a commonly prescribed pressure-relieving modality for the vast majority of activity taken each day. These results may help to at least partially explain the less-than-impressive outcomes reported from many trials that have not used effective off-loading strategies. Failure to adequately off-load the foot or modulate activity exposes the wound to repetitive stress during activity of the same magnitude that precipitated the wound in the first place (17). We postulate that tight control of both pressure reduction and activity may increase the prevalence of healing significantly.

    Activity patterns of patients with diabetic foot ulceration - Patients with active ulceration may not adhere to a standard pressure off-loading regimen

    Armstrong, DG ; Lavery, La ; Kimbriel, Hr ; Nixon, Bp ; Boulton, Ajm

    Diabetes Care, 2003 Sep, Vol.26(9), pp.2595-2597 [Peer Reviewed Journal]
     
  15. NewsBot

    NewsBot The Admin that posts the news.

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