Total contact casting
This redistributes pressure from the foot into the leg, which is more able to bear weight, to protect the wound, letting it regenerate tissue and heal.
[8] Research conducted by Paul W. Brand, MD, in the 1940s and 50s, also in India, demonstrated that the wounds in the feet were caused by nerve damage (neuropathy) rather than infection, as previously thought.
[8] Over time, the staff at Carver Hospital refined the method to reduce the development of other wounds that occur in part because of the initial problem with the foot (secondary ulceration).
The curing time of a fiberglass cast is far shorter than plaster of Paris, letting the patient walk with an outer boot within an hour of application.
Because casts made of fiberglass have lower breakdown rate and do not impede patient mobility, this material has become the choice for TCC.
[15] The result is that pressure and abrasion injuries, such as bruising and blisters caused by poor footwear, are not noticed and often ignored, and the continual use of the limb disrupts and damages the healing process.
A recent publication on the treatment of DFUs identified that the largest potential improvement in DFU care would come about through adoption of effective off-loading techniques.
Most patients need to remain mobile to continue with daily life, therefore enforced restrained bed rest or sedation are neither convenient nor recommended methods to achieve effective off loading.
Instead, various non constraining off-loading methods, from bed rest, crutches and wheelchairs, to complex fixed and removable boots are used to allow the patient continued movement.
[4] Immobilization of the ankle joint reduces pressure in the forefoot and plantar regions from the propulsion phase of walking, which occurs during forward motion.
[5][18][19][20][21][22][23][24] Lavery et al. (2014) showed that TCC had a wound closure rate of 88.9%, compared to 50% for healing sandal and 40% for shear-reducing walking boot.
Derma Sciences' TCC-EZ Total Contact Cast (acquired by Integra LifeSciences in 2017) treats diabetic foot wounds by reducing pressure and providing additional support.
[26][27] TCC-EZ's woven, prefabricated material rolls onto a patient's leg and reduces application time compared to a conventional total contact cast.
[30] M-Medical provides a traditional fiberglass total contact cast system with patented padding protection preventing iatrogenic lesions.
Total contact casting is contraindicated in the presence of untreated infection or osteomyelitis and in patients with severe peripheral arterial disease.
