Tag: total contact cast

A peek under the Cast a Total Contact Casting Primer

a Total Contact Casting Primer with Dr. Michael Miller
(A diatribe in four verses)

 

Okay fans, let’s talk about the science behind Total Contact Casting. But before we talk about the science, what is a Total Contact Cast? Well, before we talk about Total Contact Casting, let’s talk about the key to not just healing wounds but preventing them. But before we talk about preventing and healing them, we need to talk about them … wounds that is.

 

Wound is a term that usually means a defect in the epithelium, which is a five syllable word for skin. Another term you might hear is the word “ulcer”. The simplest way to differentiate these two is to remember that an ulcer arises from the inside and comes out whereas a wound starts on the outside and progresses inside. The key to understanding this is by example’s…

 

The ill equipped robber whose gun fired while he was walking into the store did not receive a gunshot ulcer, he got a gunshot wound. The bullet caused the damage from the outside, in. 

 

The person who took too many aspirin every day and started to have terrible stomach pain did not develop a gastric wound, he developed a gastric ulcer. The lining eroded from the inside out.

 

The beautiful model who could not have her picture taken had a herpes ulcer of her lip, not herpes wound. This ulcer developed from the inside of her lip to the outside

 

The patient who had his hernia fixed and then bumped the incision causing it to open, does not have a stomach ulcer, they have a stomach wound. The incision opened up from the outside exposing the inside.

 

Now that we have the definitions done, back to prevention and treatment. Of course the most obvious question that you need to ask is, what is our diagnosis (diagnoses) for either why this wound developed or what is specifically keeping it from healing?

read more

 

How To Ensure Effective Offloading With Total Contact Casting

I recently had the opportunity to speak at a dinner meeting to a group of wound care clinicians. During a question and answer session, the topic of discussion drifted toward the use of total contact casting (TCC). I asked the meeting participants to indicate, with a show a hands, how many of them were using this modality regularly in their practice. I was shocked to see that the number was less than 10 percent.

 

Numerous authors have described the underlying pathology in the development of lower extremity ulcerations. Perhaps one of the greatest difficulties in managing complex lower extremity ulcerations is offloading the wound site effectively. A review of the literature demonstrates that TCC is the “gold standard” for offloading non-infected, non-ischemic plantar foot ulcerations.1,2

 

There are several mechanisms that combine to provide the reduction of peak plantar pressures via the use of TCC. Studies have established that the use of TCC decreases altered gait mechanics with shortened stride length and an overall reduction of walking velocity, both of which contribute to the reduction of plantar pressures.3 Furthermore, given the “cone effect” provided by the physical structure of the patient’s leg (an inverted cone), the TCC (a conical receptacle) also allows more even distribution of the patient’s weight read more

Total Contact Cast Use in Patients With Peripheral Arterial Disease

As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. Objective. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use … read more

New Study, Same Conclusion …

New Study, Same Conclusion. It is time to take another look at Total Contact Casting

 

Total Contact Cast

Total Contact Cast

The most recent and perhaps the most conclusive study of for treatment of the diabetic foot is a collaboration of three prominent organizations, The Society for Vascular Surgery, the American Podiatric Medical Association and the Society for Vascular Medicine. The guidelines, “The Management of the Diabetic Foot,” were developed after three years of studies and are published online and in print in the Journal for Vascular Surgery. Dr. Anil P. Hingorani is the lead author that researched and wrote the guidelines. With diabetes a major worldwide problem and little data on treatments, the need for detailed, diabetic foot clinical guidelines from multiple disciplines was great, said Hingorani.

 

The committee synthesized the points of view of the three different medical professions by researching one another’s treatment protocols. Vascular surgeons and vascular medicine specialists read literature from podiatry and vice versa, for example, and all participants concentrated on infectious disease control and guidelines, a large component of the finished document. Collaboration was key, Hingorani said. “We had multiple disciplines looking at the problem to bring the best information from each field to develop the guidelines,” he said, though only limited “high-quality evidence” was available for many of the critical questions.

 

One of the findings that physicians may find surprising, it was the importance of the total contact cast in the treatment of plantar diabetic foot ulcers, which the committee found was is supported by robust data. Off-loading takes all direct pressure off the ulcer through use of a total contact cast. “total contact casting is so under-utilized,” Hingorani said. “I think some surgeons may find it surprising and it may raise a few eyebrows. Many surgeons are not aware of how strong the evidence is for total contact casting. It is not new but not widely understood or implemented.”
read more

Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and …

 

Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and Practice. Data from the US Wound Registry

 

Off-loading was documented in only 2.2% of 221,192 visits from January 2, 2007, to January 6, 2013. The most common off-loading option was the postoperative shoe (36.8%) and TCC (16.0%). There were significantly more amputations within 1 year for non-TCC–treated DFUs compared with TCC-treated DFUs (5.2% vs 2.2%; P = .001). The proportion of healed wounds was slightly higher for TCC-treated DFUs versus non-TCC–treated DFUs (39.4% vs 37.2%). Infection rates were significantly higher for non-TCC–treated DFUs compared with TCC-treated DFUs (2.6 vs 1.6; P = 2.1 × 10−10). Only 59 clinics used TCC (61%) … read more

How to apply a Total Contact Cast


This video demonstrates the application of the 901MF-WH Total Contact Casting Kit. Instructional dialog extends the length of the application considerably, actual application time of the Total Contact Casting Kit once comfortable with the process is approximately 5 minutes. For more information on the total contact casting kits being used visit: http://m-medusa.com