Total contact casting (TCC) is a specially designed cast designed to take weight off of the foot (off-loading) in patients with diabetic foot ulcers (DFUs). Reducing pressure on the wound by taking weight off the foot has proven to be very effective in DFU treatment. DFUs are a major factor leading to lower leg amputations among the diabetic population in the US with 85% of amputations in diabetics being preceded by a DFU.[1] Furthermore, the five-year post-amputation mortality rate among diabetics is estimated at 45% for those with neuropathic DFUs.[2]
TCC has been used for off-loading DFUs in the US since the mid-1960s and is regarded by many practitioners as the "reference standard" for off-loading the bottom surface (sole) of the foot.[3]
TCC involves encasing the patient's complete foot, including toes, and the lower leg in a specialist cast that redistributes weight and pressure in the lower leg and foot during everyday movements. 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.[4] TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound.[5]
Effective off-loading is a key treatment modality for DFUs, particularly those where there is damage to the nerves in the feet (peripheral neuropathy). Along with infection management and vascular assessment, TCC is vital aspect to effectively managing DFUs.[6] TCC is the most effective and reliable method for off-loading DFUs.[7][8][9]
^Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008, www.ahrq.gov.
^Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008, www.ahrq.gov.
^Armstrong, D.G., et al., It's not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis, 2004. 39 Suppl 2: p. S92–9.
^Raspovic, A. and K.B. Landorf, A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers. J Foot Ankle Res, 2014. 7: p. 35.
^Snyder, R.J., et al., The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes. J Am Podiatr Med Assoc, 2014. 104(6): p. 555–67.
^Snyder, R.J., et al., The management of diabetic foot ulcers through optimal off-loading building consensus guidelines and practical recommendations to improve outcomes. J Am Podiatr Med Assoc, 2014. 104(6): p. 555–67.
^Armstrong, D.G., et al., Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care, 2001. 24(6): p. 1019–22.
^Lavery, L.A., et al., Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations: a comparison of treatments. Diabetes Care, 1996. 19: p. 818–821.
^Lewis, J. and A. Lipp, Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database Syst Rev, 2013. 1: p. Cd002302.
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