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1362466017 total contact casting


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total contact casting

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1362466017 total contact casting

  1. 1. VINAYA. A.S. Clinical Podiatrist & Co - ordinator Foot Clinic Bhagwan Mahaveer Jain Hospital Bangalore Karnataka INDIA
  2. 2. TOTAL CONTACT CASTING Effective, rapid & ambulatory therapy for HEALING Diabetic neuropathic plantar ulcer (CAST APPLICATION)
  3. 3. TOTAL CONTACT CASTING • Benefits – Shortens the period of healing by off loading – Shortens bed - rest in the hospital – Reduces the cost of dressing – Prevents other complications
  4. 4. TOTAL CONTACT CASTING • In practice from the 1930s • Started with Hansen’s disease • To treat neuropathic plantar ulcerations
  5. 5. TOTAL CONTACT CASTING • TCC reduces peak plantar pressures • It increases the surface area of the foot for forefoot and mid - foot • It allows pedal ulcers to heal rapidly • Healing time with TCC is 36 to 43 days approximately
  6. 6. TOTAL CONTACT CASTING • Indication for TCC GRADE 1 & GRADE 2 plantar ulcerations in the presence of insensitivity
  7. 7. TOTAL CONTACT CASTING • Contraindication for TCC – Active or acute deep infection – Ulcer depth greater than ulcer width – Excessive leg or foot swelling – Patient unwilling to have cast on extremity
  8. 8. TOTAL CONTACT CASTING • Contraindication for TCC – Patient unwilling to comply with follow up visits or wearing precautions – Patient unsafe in mobility while in cast – Depends on doppler pressure
  9. 9. TOTAL CONTACT CASTING • Advantages – Maintains the ambulations – Reduces excessive plantar pressures – Protects foot from further trauma – Immobilisation helps localise & prevent the spread of infection – Controls oedema – Requires minimum patient compliance
  10. 10. TOTAL CONTACT CASTING • Disadvantages – Impairs mobility (walking,performing basic and instrumental activities of daily living, balance, co - ordination) – Joint Stiffness – Muscle atrophy - if immobilisation is prolonged – Skin abrasions – New ulcerations if cast is poorly applied – poor monitoring (foul odour due to drainage)
  11. 11. TOTAL CONTACT CASTING • Cast Application – Trace the ulcer – Cover it with thin dressing – Foam covering for bony prominences – Cover the bony prominences with first layer of cast – Cover medial,lateral,posterior and plantar walls of the cast – Wait for 24 hours to allow the inner layers to thoroughly set.
  12. 12. TOTAL CONTACT CASTING Instructions to Patients • Inform podiatrist in case of : – Any swelling – Cast is tight – Loosening or excessive mobility of the foot in the cast – Drainage on the outside of the cast – Deep cracks or soft spots in the cast – Sudden tenderness on the inguinal lymph nodes
  13. 13. TOTAL CONTACT CASTING TCC is the “Gold Standard” among the methods used to heal “Diabetic Foot Ulcers” Supports • Numerous clinical reports • One controlled clinical trial over the past 25 years
  14. 14. TOTAL CONTACT CASTING TCC and other off - loading methods remain the “corner - stone” for healing “pedal ulcers” TCC may be used in conjunction with other methods
  15. 15. Thank You For more details mail at: