1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers

Fleischli, John G.; Lavery, Lawrence A.; Vela, Steven A.; Ashry, Hisham R.; Lavery, David C.

doi:10.7547/87507315-87-10-466

Cited by 77 publications

(93 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The nonremovable TCC and the RCC were similar in many aspects, and earlier studies did not show a difference in pressure relief between these two modalities (30,31). As suggested earlier (32), part of the efficacy of the nonremovable TCC is possibly related to the "forced compliance" for off-loading.…”

Section: Nabuurs-franssen and Associatesmentioning

confidence: 50%

Total Contact Casting of the Diabetic Foot in Daily Practice

et al. 2005

View full text Add to dashboard Cite

OBJECTIVE -A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.RESEARCH DESIGN AND METHODS -Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.RESULTS -Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P Ͻ 0.01). In multivariate analyses, PAD, infection, and heel ulcers were associated with a lower percentage healed (all P Ͻ 0.05). Median duration of cast treatment was 34 days. New ulcers, all superfical, developed in 9% and preulcerative lesions in 28% of the patients; these skin lesions healed in the cast within a maximum of 13 days.CONCLUSIONS -In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment. Diabetes Care 28:243-247, 2005O ff-loading of the wound is one of the key elements in treating diabetic (neuropathic) foot ulcers (1). Several off-loading devices are available, such as walkers, half shoes, orthoses, felted foam, and the total contact cast (TCC) (2-5), which is seen as the definitive standard therapy (2,6 -8). There are three randomized clinical trials (6 -8) published on the effectiveness of TCCs in neuropathic plantar foot ulcers, in which a nonremovable TCC was compared with no offloading (6), a removable aircast walker (7), and/or a shoe modality (8). These studies concluded that a TCC healed a higher proportion of neuropathic, noninfected ulcers in a shorter amount of time, with healing rates of ϳ90%.Although a TCC seems a highly attractive off-loading modality, several disadvantages have been reported: new ulcers may occur, daily wound care is not possible, mobility is impaired, costs may be relatively high, and specialized staff seems necessary (3). In the case of prolonged casting, joint rigidity and muscular atrophy have been documented (7). Finally, the above described trials were performed in centers of excellence in patients with superficial, noninfected, nonischemic, plantar ulcers, and numbers were relatively small. When combined, these published randomized controlled trials reported on 66 patients treated with TCC. Although from a biomechanical point of view off-loading is indicated in most patients, o...

show abstract

Section: Nabuurs-franssen and Associatesmentioning

confidence: 50%

Total Contact Casting of the Diabetic Foot in Daily Practice

et al. 2005

View full text Add to dashboard Cite

show abstract

“…This applies, in particular, to TCC [15][16][17]. Peak pressure was also significantly reduced in a bi-valved total contact cast and the Aircast walker compared to a control shoe (p < 0.01) [12].…”

Section: Foot Offloading and Postural Stabilitymentioning

confidence: 77%

Footwear for the neuropathic patient: offloading and stability

Deursen

2008

Diabetes Metab. Res. Rev.

View full text Add to dashboard Cite

Diabetic neuropathy is related to plantar ulceration through a variety of factors of which increased plantar pressures and loss of protective sensation are the most important. Loss of sensation in the lower limbs is also related to postural instability and an increased risk of falling. Ankle and foot proprioception play an important role in postural control and this sensory function is also affected by neuropathy. It is conceivable that footwear, orthotics, casts and braces used for treatment or prevention of plantar ulceration through offloading of the injured or at-risk foot area can exacerbate the postural instability and risk of falling. This has, however, received very limited attention in the literature. There are studies that have demonstrated that footwear adjustments can influence balance and stability in healthy, elderly subjects. The adjustments made to footwear for the diabetic foot are generally more dramatic and, therefore, are expected to have a greater influence on postural stability. Furthermore, casts and braces tend to deviate even more from normal footwear. This may seriously interfere with normal gait and posture and, therefore, stability. So far the evidence suggests that patients wearing such devices demonstrate markedly reduced activity levels. This reduced activity could add to the effect of offloading. This could also be interpreted to indicate problems with stability. This presentation will review the different types of offloading interventions frequently used for ulcer treatment and prevention and will consider the mechanical effect of these interventions on stability.

show abstract

“…Removable walkers were shown to be as effective as TCCs and more effective than forefoot offloading shoes and extra-depth shoes in reducing forefoot peak pressures [87,88]. Forefoot offloading shoes were found to be more effective than accommodative felt and foam dressings (worn in a post-operative shoe) or post-operative shoes alone [87]. The heel region was found to be best offloaded with a TCC, followed by removable walkers, which, in turn, were more effective than depth-inlay shoes [86].…”

Section: Other Offloading Interventionsmentioning

confidence: 99%

“…However, five uncontrolled studies on this topic were identified [86][87][88][89][90]. TCCs appear to offload the affected extremity effectively.…”

Section: Plantar Pressure Reductionmentioning

confidence: 99%

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Bus

Valk

Deursen

et al. 2008

Diabetes Metab. Res. Rev.

219

182

View full text Add to dashboard Cite

SummaryBackground Footwear and offloading techniques are commonly used in clinical practice for the prevention and treatment of foot ulcers in diabetes, but the evidence base to support this use is not well known. The goal of this review was to systematically assess the literature and to determine the available evidence on the use of footwear and offloading interventions for ulcer prevention, ulcer treatment, and plantar pressure reduction in the diabetic foot.

show abstract

1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers

Cited by 77 publications

References 15 publications

Total Contact Casting of the Diabetic Foot in Daily Practice

Total Contact Casting of the Diabetic Foot in Daily Practice

Footwear for the neuropathic patient: offloading and stability

The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review

Contact Info

Product

Resources

About