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1362466017 total contact casting
Total contact casting is an effective and ambulatory therapy for healing diabetic neuropathic plantar ulcers. It offloads pressure and shortens healing time to 36-43 days by immobilizing the foot and redistributing pressure. Total contact casting is indicated for grade 1 and 2 plantar ulcers with insensitivity and contraindicated for active infection, ulcers deeper than wide, or excessive swelling. It maintains ambulation while reducing pressure and protecting the foot during healing.
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1362466017 total contact casting
- 1. VINAYA. A.S. Clinical Podiatrist & Co- ordinator Foot Clinic Bhagwan Mahaveer Jain Hospital Bangalore Karnataka INDIA
- 2. TOTAL CONTACT CASTING Effective,rapid & ambulatory therapy for HEALING Diabetic neuropathic plantar ulcer (CAST APPLICATION)
- 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. TOTAL CONTACT CASTING •In practice from the 1930s • Started with Hansen’s disease • To treat neuropathic plantar ulcerations
- 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. TOTAL CONTACT CASTING •Indication for TCC GRADE 1 & GRADE 2 plantar ulcerations in the presence of insensitivity
- 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. 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. 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. 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. 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. TOTAL CONTACT CASTING Instructionsto 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. TOTAL CONTACT CASTING TCCis 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. TOTAL CONTACT CASTING TCCand other off - loading methods remain the “corner - stone” for healing “pedal ulcers” TCC may be used in conjunction with other methods
- 15. Thank You For moredetails mail at: vinaya_as@rediffmail.com