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Case 1.10
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
What is total contact casting?This is the recognized gold standard treatment for diabetic foot ulceration and a Charcot foot. It is made of non-fibreglass tape that is designed to:offload pressure on the plantar aspect,increase total surface area of the midfoot and forefoot during weightbearing, thereby reducing peak pressures,shorten the wound healing time, andincrease patient compliance as it cannot be removed by the patient.However, contraindications to its use include infection and ischemia.
Foot Care in Older Adults with Diabetes Mellitus
Published in Medha N. Munshi, Lewis A. Lipsitz, Geriatric Diabetes, 2007
Aristidis Veves, Thomas E. Lyons
Total contact casting has been considered the most effective means of off-loading diabetic foot ulcers as measured by wound-healing rate (88). Described by Paul Brand, total contact casting involves the use of a well-molded minimally padded plaster cast to distribute pressures evenly to the entire limb. It allows for patient mobility during treatment and has been found to help control edema linked to impairment of healing (89). The main advantage and likely effectiveness of total contact casting however is the forced patient compliance due to the inability to remove the apparatus. Disadvantages include the considerable skill and time required for application, the possibility of secondary skin lesions due to cast irritation especially in the elderly, and the inability to assess the wound daily. It is rarely used in elderly patients who might be frail and prone to falls.
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Conservative treatment centers around patient education paired with off-loading techniques. Advise the patient on the importance of fitting shoes with an wide-toe box [33,34]. Sandals are recommended to accommodate the dorsiflexed MTP joint while high heels are contraindicated. Other shoe modifications include shoes with a wide-toe box, soft upper toe box with no stitch lines, budin splints, and metatarsal pads (Figure 6). Silicon toe sleeves can also be used to reduce rubbing on the top of the toe and prevent possible ulceration [34]. Off-loading techniques are varied and can encompass insoles to relieve pressures, toe spacers, post-operative shoes, controlled ankle motion walker, or total contact casting in order to prevent ulcers in diabetics [35].
Dehydrated human amnion and chorion allograft versus standard of care alone in treatment of Wagner 1 diabetic foot ulcers: a trial-based health economics study
Published in Journal of Medical Economics, 2020
To simplify cost calculations all offloading devices were assumed to be the removable diabetic offloading cam-walkers (boots) used in the trial as true total contact casting rarely occurred. In group 1, 29/40 of wounds (72.5%) were offloaded, while in group 2, 31/40 of wounds (77.5%) were offloaded. A new walking boot was provided 4 times a year.