Total contact casting
(TCC) is an especially designed cast
designed to take bodyweight off of the foot (off-loading) within patients with
diabetic feet ulcers (DFUs). Reducing pressure on
the wound by taking weight from the foot has shown to be very effective within
DFU treatment. DFUs can be a major factor leading to leg amputations among the
diabetic inhabitants in the US with 85% involving amputations in diabetics
being preceded with a DFU.
Additionally, the 5-year post-amputation fatality rate among
diabetics is estimated with around 45% for those struggling with neuropathic
DFUs.
Total contact casting kits continues
to be used for off-loading DFUs in America since the mid-1960s and it is
regarded by many practitioners as the “reference standard” for off-loading the
bottom surface (sole) of the feet.
TCC consists of
encasing the patient’s complete feet, including toes, and also the lower leg in
a specialist cast that redistributes weight and stress in the lower leg and
feet during everyday movements. This particular redistributes pressure from the
foot in the leg, which is more able to bear weight, to safeguard the wound,
allowing it to regenerate tissue and heal. TCC also keeps the ankle from
rotating during strolling, which prevents shearing and twisting forces that can
further damage the wound.
Effective away loading
is a key treatment technique for DFUs, particularly those that result in damage
to the nerves in the feet (peripheral neuropathy). Along with disease
management and vascular evaluation, TCC is a vital
aspect to effectively controlling DFUs. TCC is considered the most effective
and reliable means for off-loading DFUs.
The usage of TCC for
feet ulcers caused by leprosy (Hansen's disease) was through Joseph Khan in
India within the 1930s. Research conducted by simply Paul W. Brand, MD, in the
1940s and 50s, also in Indian, demonstrated that the wounds within the feet
were caused by sensation problems damage (neuropathy) rather than disease, as
previously thought. In the use of TCC to eliminate weight and pressure about
the ulcers, he observed the healing of ulcers that were present for a long
period. These types of seminal observations resulted in the introduction of
treatments to manage neuropathic foot ulcers that are useful for patients with
a diabetic.
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