Total contact casts: Pressure reduction at ulcer sites and the effect on the contralateral foot

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.

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“…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%

“…Shoes with a rocker-bottom outsole were found to be effective in reducing forefoot peak pressures [91]. Footwear with some sort of molded insole also provided significant reductions in plantar pressure [88,89,[92][93][94][95][96][97][98][99][100][101][102]. Shoes with flat insoles were less effective [99].…”

Section: Footwearmentioning

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

183

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mentioning

confidence: 97%

Revisiting the Total Contact Cast

et al. 2005

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A lthough the benefits of total contact casting for healing plantar neuropathic ulcers are consistent throughout a large body of available literature, the method of cast application varies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Cast structure at the ulcer site provides one major variance, i.e., should the cast create total contact with the entire plantar surface of the foot or should the wound be isolated? This article aims to resolve this issue by examining the differences in plantar pressure at the wound site between total contact casting using full contact with the plantar aspect of the foot and wound isolation. RESEARCH DESIGN ANDMETHODS -A total of 10 healthy adult subjects (aged 28 Ϯ 13 years, height 1.81 Ϯ 0.1 m, and weight 92.6 Ϯ 18 kg) with focal areas of pressure (but no history of ulceration) under their metatarsal heads were recruited. For each subject, a region of interest (ROI) was selected to encompass areas of particularly high pressure. This study was approved by the Institutional Review Board of the Cleveland Clinic Foundation, and all subjects signed informed consent forms. A Pliance pressuresensitive array (Novel) was fixed directly to the subject's foot covering the ROI. The 16 ϫ 16 sensor array had a sensor size of 19.36 mm 2 and a sampling rate of 50 Hz. Subjects were timed while they walked 10 m barefoot with the sensor held in place using thin paper tape. The pace was self-selected but measured to provide reproducible speeds under the different conditions. The subjects were then cast with the sensor in place over the ROI using one of two casting methods, A or B, selected at random. Casting method A created a true total contact cast (TCC), and casting method B created a woundisolation TCC (Fig. 1). Details of casting techniques are provided in the online appendix (available at http://care.diabetes journals.org). Both methods presented here used fast-setting fiberglass cast materials (3M Health Care). All casts were applied by the same trained personnel with previous TCC experience.Once the subject was comfortable walking in the cast, he/she was timed walking 10 m in the cast while pressure data were recorded. After the data were collected, the cast was removed with an oscillating cast saw, taking care to avoid moving or damaging the embedded sensor. The second type of cast was then immediately applied with the sensor array fixed in the same position, and the data collection procedure was repeated.Five steps from the middle portion of the walk were averaged for each trial using Novel step analysis and averaging software. A 5-cm diameter circular area was identified near the center of the sensor array such that it included the ROI selected for each patient. The peak pressure and pressure-time integral in these regions were calculated. The same regions were used to examine data from barefoot walking, walking in a conventional TCC without wound foam, and walking in a wound-isolation TCC with wound foam. Time-matched trials were used for comparison to eliminate the effect...

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“…Indeed, for many years standardized bench tests have been performed on a variety of soling materials for the shoe industry (16). The primary aim of many therapeutic in-shoe devices is to redistribute pressure to other regions of the foot by allowing other parts of the foot to bear weight during standing and walking (17,18). Because socks may offer the first line of defense to the at-risk foot, several studies have provided some direct evidence that padded hosiery can reduce peak plantar pressures (19,20) and indirect evidence that they can reduce friction and shear by the reduction in occurrence in blisters (21).…”

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confidence: 99%

Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

2005

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OBJECTIVE -High plantar pressure is an acknowledged risk factor in the development of plantar ulcers in the diabetic neuropathic foot. This study examines the ability of preventive foot care (PFC) socks to reduce plantar foot pressures in a sample of high-risk patients with diabetes.RESEARCH DESIGN AND METHODS -Nineteen patients with established peripheral neuropathy attending a complications clinic of the Manchester Diabetes Centre were recruited to the study. Fifteen (78%) of the patients were male, 40 -80 years of age, and ulcer-free at the time of recruitment. In-shoe plantar pressure measurements were recorded using the F-Scan and compared PFC socks with ordinary supermarket socks. The analysis measured differences in maximum foot contact area and plantar pressure for the whole foot, forefoot, and peak plantar pressure areas. RESULTS-The results showed a significant increase in maximum foot contact area of 11 cm 2 (95% CI 7-11) when subjects wore the PFC socks (P Ͻ 0.01). This was accompanied by 5.4 kPa (3.5-7.3) or 9% reduction in total foot pressure (P Ͻ 0.01). Similar results were observed at the forefoot, which showed a 14.2% increase in contact area and a 10.2% reduction in peak forefoot pressure.CONCLUSIONS -These results suggest that the wearing of PFC socks increases the underfoot contact area and hence decreases plantar foot pressures. Further studies are required to determine whether the pressure and friction reductions achieved by this simple intervention would be effective in reducing the incidence of foot ulcers in high-risk patients. Diabetes Care 28:2001-2006, 2005T he personal and health care costs associated with diabetic foot ulcers are well recognized. It has been estimated that ϳ2% of the diabetic population will have an active foot ulcer (1) and a similar proportion will develop a new lesion each year (1,2). Many factors are associated with the development of foot ulcers including neuropathy, deformity, and trauma (3,4). It is also recognized that although neuropathy is a major contributory factor in the development of ulcers, the ulcer is usually preceded by unrecognized minor tissue damage, commonly from footwear (5). It is not surprising, therefore, that footwear is considered to be an important and modifiable risk factor for foot ulceration.The main stresses that act upon the feet are step shock, pressure, friction, and shear. These stresses often occur together to damage insensitive and delicate foot structures.Step shock is the impact force generated by the body, particularly as the foot makes initial contact with the ground. This impact force is thought to be associated with a variety of bone and soft tissue disorders affecting the foot as well as other structures in the body (6). Not only have high plantar pressures been implicated in the development of foot ulcers (7,8) but also the offloading of diabetic foot ulcers is now also considered to be an essential component of foot wound management (9 -11). Friction is the static or active force that acts on the skin and resists slid...

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Total contact casts: Pressure reduction at ulcer sites and the effect on the contralateral foot

Cited by 44 publications

References 13 publications

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

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

Revisiting the Total Contact Cast

Efficacy of Multilayered Hosiery in Reducing In-Shoe Plantar Foot Pressure in High-Risk Patients With Diabetes

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