The total-contact cast for management of neuropathic plantar ulceration of the foot.

Myerson, Mark S.; Papa, J; Eaton, K. K.; Wilson, Kenneth H.

doi:10.2106/00004623-199274020-00012

Cited by 156 publications

(124 citation statements)

References 0 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…When the Active Offloading Walker was modified, the iTCC study group demonstrated a healing rate similar (86% in 12 weeks) to that in previous studies that used a traditional TCC as the off-loading treatment. There is a large body of literature that reports consistently high rates of healing (73-100%) with TCCs (Table 2) (3,4,6,7,9,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). However, because TCCs are technically difficult to use and time consuming to place, they are not widely used in most clinics worldwide.…”

Section: Results -Descriptive Characteristics Of the Populations Are mentioning

confidence: 99%

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

et al. 2005

View full text Add to dashboard Cite

OBJECTIVE -The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations. RESEARCH DESIGN AND METHODS -We randomly assigned 50 patients withUniversity of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.RESULTS -An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P ϭ 0.02, odds ratio 1.8 [95% CI 1.1Ϫ2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 Ϯ 18.7 vs. 58.0 Ϯ 15.2 days, P ϭ 0.02).CONCLUSIONS -Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds. Diabetes Care 28:551-554, 2005A melioration of pressure, shear, and repetitive injury to the sole of the foot are principal tenets of neuropathic ulcer care. Total contact casts (TCCs) are considered the gold standard in redistribution of pressure over the plantar aspect of the diabetic foot (1-7). TCCs have been shown to reduce pressure at the site of ulceration by 84 -92% (8), and there is a large body of work that supports the TCC's clinical efficacy. In two randomized controlled trials comparing the proportion of healed ulcers treated with a TCC compared with other readily available and popular devices (removable cast walkers [RCWs], half-shoes, and therapeutic depth inlay shoes) TCCs, healed a higher proportion of wounds compared with other modalities (7,9). This was an interesting finding because certain types of RCWs, including one used in one of the above-mentioned trials, often reduce pressure on the plantar aspect of the foot as well as TCCs (9). If patients do not heal as well in the RCW and yet it off-loads pressure about as well as the TCC, then a logical explanation for their less effective clinical performance is that these devices are being removed by the patients that use them (10).In an effort to make the RCW more efficacious, we have modified it slightly by merely wrapping the traditional RCW in a layer of cohesive or plaster bandage. This technique has been termed the "instant" TCC (iTCC) (11). It has been our initial experience that this technique is clinically successful. If clinical results are superior to those with the RCW, we believe it could potentially auger a significant shift in the current standard of care in pressure reduction (off-loading) of diabetic wounds. We are unaware of any reports in the literature that have compared a standard RCW with the iTCC. The purpose of this project was to evaluate the effectiveness of a traditional RCW and the iTCC to heal neuropathic foot ulcerations in pa...

show abstract

Section: Results -Descriptive Characteristics Of the Populations Are mentioning

confidence: 99%

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

et al. 2005

View full text Add to dashboard Cite

show abstract

“…It has a rocker sole created by layering standard plaster on the bottom of the cast from the heel to an area just proximal to the metatarsal heads, facilitating ambulation. [91] Recent evidence suggests that good results may also be achieved by use of the "instant Total Contact Cast," a removable cast walker rendered irremovable by wrapping in a layer of cohesive or plaster bandage. [89] In case casting facilities are not available, alternative offloading modalities include temporary ready-made shoes with a cushioning insole, special half shoes for forefoot ulceration, or other orthotic devices.…”

Section: The Diabetic Foot In Renal Failure: Prevention and Treatmentmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

View full text Add to dashboard Cite

Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

show abstract

“…3 1990-2000'li yıl lar da, di ya be tik nö ro pa ti ye bağ lı ayak plan tar yüz kro nik ül ser le ri nin te da vi sin de TTA'nın et ki li bir yön tem ol du ğu nu bil di ren çok sa yı da ça lış ma ya yın lan mış tır. 2,[4][5][6][7][8][9][10][11][12] Bu gün, his siz ayak lar da or ta ya çı kan ya ra la rın te da vi sin de %100'e va ran ba şa rı ora nı na sa hip olan TTA' ya, "altın stan dar t" te da vi yön te mi ola rak ba kıl mak tadır. [13][14][15][16] Ül ke miz de, TTA ile il gi li bu gü ne ka dar ya yın lan mış tek bir ça lış ma tes pit ede bil dik.…”

Section: Plastic Reconstructive and Aesthetic Surgeryunclassified

“…Al çı uy gu la ma sın dan son ra ilk kon trol ve al çı de ği şi mi nin ye din ci gün, on dan son ra ki kon trol ve al çı de ği şim le ri nin 1-2 haf ta aray la yapıl dı ğı yay gın bir uy gu la ma nın ol du ğu gö rül mekte dir. 2,12,16,17,27 Sık ara lık lar la kon trol el bet te il ke ola rak doğ ru dur. Al çı bü tün lü ğün de en ufak bir bozuk lu ğun, ye ter siz li ğin bu kon trol ler de ya ka lanma sı ve al çı nın ye ni len me si ge rek li ola bi lir.…”

Section: Plastic Reconstructive and Aesthetic Surgeryunclassified

“…TTA uy gu la ma la rı ile il gi li ya yın lar da iyi leş -me sü re si ola rak, epi te li zas yo nun ta mam lan dı ğı (ya ra nın ka pan dı ğı) gün esas alın mış 2,6,12,27 ve ya ra iyi leş tik ten son ra al çı sız yü rü me ye na sıl ge çil di ği ko nu sun da kı la vuz bil gi le rin ek sik ol du ğu gö rül -müş tür. Epi te li zas yo nun ta mam lan dı ğı gü nün, yara nın iyi leş ti ği gün ola rak be lir til me sin de an la ş-ıl maz bir du rum yok tur.…”

Section: Plastic Reconstructive and Aesthetic Surgeryunclassified

See 1 more Smart Citation

Management of Diabetic Neurotrophic Foot Ulcers with Total Contact Cast: A Serial of 44 Cases

Altındaş¹,

Ceber²,

Bağhaki³

2011

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

Ö ÖZ ZE ET T A Am ma aç ç: : Di ya be tik nö ro pa ti ye bağ lı ül ser ler, his siz ayak la rın en sık kar şı la şı lan so ru nu dur. Ço -ğu kro nik leş miş olan bu lez yon la rın bir den bi re alev len me si so nu cu, eks tre mi te yi, hat ta ha ya tı teh dit eden akut ve iler le yi ci di ya be tik ayak en fek si yon la rı or ta ya çı kar. Bu di ya be tik ayak lez yonla rı nın önem li bir bö lü mün de ke mik, ek lem ve ten don tu tu lu mu var dır. Bun la rın te da vi si için hemen her za man cer ra hi gi ri şi me ih ti yaç olur. Ke mik ve ek lem tu tu lu mu ol ma yan ol gu la rın te da vi sin de ise cer ra hi dı şı bir te da vi olan to tal te mas al çı sı (TTA) son iki de kad da ön pla na geç-miş ve "al tın stan dar t" de ğe rin de bir te da vi yön te mi ha li ne gel miş tir. 2000'li yıl la rın ba şın dan itiba ren de TTA' yı di ya be te bağ lı nö rot ro fik ül ser le rin te da vi sin de uy gu la mak ta yız. Bu ya zı da, to tal te mas al çı sı tek ni ği nin ta nı tıl ma sı, al dı ğı mız so nuç la rın su nul ma sı amaç lan mış tır. G Ge e r re eç ç v ve e Y Yö ön n--t te em m l le er r: : Ayak ta ba nın da kro nik nö rot ro fik ül se ri olan ve TTA uy gu la dı ğı mız ol gu sa yı sı 44 ol muş-tur. Bir ol gu al çı yı to le re ede me di ği için ilk haf ta için de al çı çı kar tıl dı. Ol gu la rı mı zın yaş or ta la ma sı 59 yıl, di ya bet le or ta la ma ya şa ma sü re le ri 20.3 yıl idi. Has ta la rın ül ser le ya şa ma sü re le ri ise or tala ma 27 ay idi. B Bu ul l g gu u l la ar r: : Ol gu la rı mı zın tü mün de ya ra la rın iyi leş me si sağ lan dı. Or ta la ma TTA sayı sı ikinin çok az üze rin dey di, 14 ol gu da (%32.5) tek al çıy la iyi leş me yi sağ la dık. Dokuz ol gu da (%20.45) al çı vu ru ğu komp li kas yo nuy la kar şı laş tık. Bir yıl lık iz lem sü re sin de 43 ol gu nun 11'in de (%25.5) ül se rin ay nı yer de tek rar la dı ğı nı gör dük. S So o n nu uç ç: : To tal te mas al çı sı nın his siz ayak lar da gü-ve ni lir ve çok et ki li bir te da vi yön te mi ol ma sı nın ya nın da bu uy gu la ma lar dan el de edi len bil gi ve de ne yim le rin bu alan da ki so run la rın çö zü mü ne kat kı sağ la ya ca ğı na ina nı yo ruz.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Diabetes mellitus; ayak ülseri; kalıplar A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Ulcers related to diabetic neuropathy are the most common problems of insensitive feet. Acute and progressive diabetic foot infections threatening the extremity and even life arise as the result of sudden exacerbation of these mostly chronic lesions. Bone, joint and tendon involvements are present in a big proportion of these diabetic foot lesions. Surgical interventions are almost always required for their treatment. Total contact cast (TCC) is a non-surgical treatment prominenced in the last two decades and became a 'gold standard' treatment modality for management of cases without bone and joint involvement. We have been using TCC for management of neurotrophic ulcers related to diabetes since the beginning of 2000s. In this paper,...

show abstract

The total-contact cast for management of neuropathic plantar ulceration of the foot.

Cited by 156 publications

References 0 publications

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds

The Diabetic Foot in End Stage Renal Disease

Management of Diabetic Neurotrophic Foot Ulcers with Total Contact Cast: A Serial of 44 Cases

Contact Info

Product

Resources

About