The DFU Dilemma: Is the Total Contact Cast a True “Gold Standard”?

McGuire and Sebag wrote: “Early diagnosis and intervention for diabetic foot wounds is essential for the prevention of complications associated with these ulcers. We are all familiar with the term ‘the golden hour’ with respect to the first 60 minutes after the onset of a stroke or cardiac arrest. The rapid initiation of aggressive care is the key to positive outcomes for the patient. In this way, the diabetic foot ulcer (DFU) also has a golden hour. The 4-week period following the onset of a diabetic ulcer is a critical time for treatments aimed at preventing the development of a chronic wound, staving off infection, and allowing for early closure of the skin. Wounds that have not achieved 50% closure within the first 4 weeks are destined to become difficult-to-heal chronic wounds. A fundamental component of early intervention and resolution of diabetic foot ulcers is the use of an array of offloading devices that includes everything from total contact casting to depth shoes with molded inserts.”1 However, as they go on to document, there is no consensus among practitioners … read more