The total contact cast: controversy in offloading the diabetic foot
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Sophie Whitelaw
British Journal of Community Nursing, Vol. 17, Iss. 12 - Supp, 13 Dec 2012, pp S16 - S20
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Type A personality traits in patients with a diabetic foot ulcer
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3D-printed scaffold in chronic wound treatment:
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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
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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
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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.
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Evaluating Iatrogenic Complications of the Total-Contact Cast
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Journal of the American Podiatric Medical Association: January 2016, Vol. 106, No. 1, pp. 1-6.
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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
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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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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
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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.
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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 -
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] -
Foot Ulcers: A Different Technique to Total Contact Casting for Healing Chronic
Foot Ulcers
Maria Shaw
Journal of Nursing & Healthcare (full text) -
Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review.
Tickner A et al
Wounds. 2018 Feb;30(2):49-56.
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A narrative review of the benefits and risks of total contact casts in the management of diabetic foot ulcers
Grace Messenger et al
Journal of the American College of Clinical Wound Specialists 7 June 2018
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A ten-year retrospective study investigating the rate of venous thromboembolism in patients who require immobilization in a total contact lower limb cast
X. N. Tonge, J. C. Widnall, G. Jackson, S. Platt
Bone Joint J 2019;101-B:691–694.
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TCC is a good offloading option but the fact that a patient may not be able to drive home, especially if the right foot/leg is casted. Like many areas, public transportation is minimal so anything that interferes with driving will be underutilized.
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PodCast: A rural and regional service model for podiatrist-led total contact casting.
McLean A, Gardner M, Perrin B
Aust J Rural Health. 2019 Sep 11
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Risk of Complications with the Total Contact Cast in Diabetic Foot Disorders
Alexandria Riopelle, BA, Ryan LeDuc, BS, Michael S. Pinzur, MD, ...
Foot & Ankle Orthopaedics October 28, 2019
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Ease of Application and Removal of Common Total-Contact Cast Systems Used in the Podiatric Medical Community.
Ludwig K, Homer V, Jensen J.
J Am Podiatr Med Assoc. 2019 Nov
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Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders
Alexandria Riopelle, BA, Ryan LeDuc, BS, Michael Wesolowski, MPH, ...
Foot & Ankle Specialist December 31, 2019
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Time to Address Total Contact Cast (TCC) as
Indian TCC
Amit Kumar C Jain
Asian Journal of Research in Surgery
7(1): 23-26, 2022; Article no.AJRS.87135
<
Type A personality traits in patients with a diabetic foot ulcer
|
3D-printed scaffold in chronic wound treatment:
>
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