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Unloading mechanism in the total contact cast.

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jun 23, 2006.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Unloading mechanism in the total contact cast.
    Foot Ankle Int. 2006 Apr;27(4):281-5
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A novel approach to mapping load transfer from the plantar surface of the foot to the walls of the total contact cast: a proof of concept study
    Lindy Begg, Patrick McLaughlin, Leon Manning, Mauro Vicaretti, John Fletcher and Joshua Burns
    Journal of Foot and Ankle Research 2012, 5:32
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes.
    Begg L, McLaughlin P, Vicaretti M, Fletcher J, Burns J.
    J Foot Ankle Res. 2016 Jan 7;9:2
     
  5. David Smith

    David Smith Well-Known Member

    From the results of the research posted above its seem clear that a foot and shank TCC reduces Plantar pressure more effectively than just a foot only TCC.

    However one wonder whether the conclusion that the shank TTC acts to suspend the foot from the shank portion of the cast is a reasonable assumption to make from the data gathered.

    The reason I say this is because the pressure data in the shank portion may be quite unreliable in terms of what they were actually measuring.

    So because the pressure sensors only measure normal force and not shear forces:

    1) The measured pressure/force applied to the tibial shank in resting stance by the cast would be a function of the vertical force * sin of the contact angle.

    2) The pressure/force applied to the tibial shank during walking (especially at the anterior and posterior shank) would be a function of the above plus the force transmitted due to moments acting about the ankle fulcrum of the cast due to GRF acting on the plantar aspect of the cast and foot.

    EG in the propulsive phase the plantar GRF acting on the f/foot is causing dorsiflexion moments about the ankle that are resisted by forces at the anterior tibial shank causing causing dorsiflexion moments. This then off loads the Achilles tendon that would usually bear that resisting force. Therefore it may be possible that the stiffness of the plantar aspect of the TCC may be attenuating the applied forces across the whole plantar surface rather than just the forefoot as would happen at heel lift / propulsive phase in normal walking.
     
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