Total Contact Cast (TCC) – Managing Diabetic Foot Ulcers. Total Contact Cast (TCC) is a very important method in treating diabetic foot ulcers. The cast covers the entire foot and lower leg and helps distribute body weight evenly when standing or walking. This is very important in removing pressure from any given area of the diabetic foot. Most diabetic foot ulcers are a result of diabetes related neuropathy and poor circulation. This causes the person with diabetes to be more prone to injury or even infection in the foot. The diabetic foot ulcer is then further protected from additional injury by immobilizing the foot in a cast. This in turn allows the body to start the natural healing process of the wound.
Healing of diabetic foot ulcers with the help of TCC is described in research by Udovichenko et al. (2013). According to this research, patients with diabetic foot ulcers who were treated with a Total Contact Cast had better results of healing than patients with similar conditions who were treated in other ways. The main reason for that is the fact that TCC prevents any additional injury to the ulcer. It does that by immobilizing the foot with the ulcer on it. In that way, any movement that could cause additional damage to the wound is prevented. In addition, TCC redistributes the weight of the body away from the ulcer. That creates conditions that are ideal for the process of healing of the damaged tissue. Patients with diabetes have problems with healing of wounds in general. That is why it is very important to create such conditions that would help the body to heal the wound as soon as possible.
Even when using a TCC in diabetic foot ulcer treatment, other methods can be used to complement its effect and thus achieve better results. For example, in a study by Serena et al. (2021) the TCC was combined with topical oxygen therapy, which is also used as a standalone treatment. Because the TCC protects the foot and fixes it in place, it prevents any further damage to the tissue, while the topical oxygen therapy boosts the healing process by increasing oxygen supply to the damaged area. So, the use of a TCC is just one aspect of a more comprehensive approach to treating patients. In general, diabetic foot ulcers are treated using a variety of methods. Each individual method, whether used on its own or in combination with other treatments, is designed to promote healing. So, as part of a broader strategy, the TCC is just one of the many possible ways to treat and heal diabetic foot ulcers.
The Total Contact Cast (TCC) is a very useful device for managing diabetic ulcers. TCCs are able to improve the rate of healing of diabetic ulcers. The devices evenly distribute body weight across the surface of the foot and reduce pressure on areas with diabetic foot ulcers. The cast protects the ulcers from further injury, and prevents re-opening. The device also protects the ulcers from further contamination, which can cause more problems. In many instances, patients with diabetic foot ulcers who are treated with TCCs, experience better results than patients who undergo surgery, such as arthrodesis (Wang et al., 2015). The use of a TCC for patients with diabetic foot ulcers, often results in patients with diabetic foot ulcers to heal more quickly, with fewer complications. The cast immobilizes the foot and aids in the body’s natural healing process of the wound.
In general, the application of the TCC can also be associated with several complications. Most of the complications reported are skin related. During the application of the cast, the skin can be subjected to pressure and might get irritated. This might result in ulcers or in severe cases, in the breakdown of the skin. In order to be able to diagnose early signs of complications, the cast must be monitored regularly and the skin checked for possible irritation. Udovichenko et al. (2013) reported a high rate of complications due to the TCC. Other complications that have been reported are those related to the prolonged immobility of the foot such as joint stiffness, muscle atrophy and deep vein thrombosis. These risks can be managed when healthcare providers are aware of the potential complications and take them into consideration.
It is so very important to inform and educate the patient and their family members as to the best skin care of the foot. Patients also need to be informed and educated as to the signs and symptoms of complications that may arise and to follow up with their healthcare provider on a regular basis. The TCC can be combined with innovative other methods of treatment, for example, the use of dehydrated amniotic membrane allografts. These can provide extra support to aid in the healing of the diabetic foot wound. It has been shown that the use of TCC and dehydrated amniotic membrane allografts has increased results in patients with diabetic foot ulcers. Abdo (2016) described his results using these two methods in treating diabetic foot ulcers. A comprehensive approach to the management of patients with diabetes is also important in addressing the many health problems that this patient population faces. Patients with diabetes are at risk for many foot and ankle problems that can be very serious and even life-threatening. All of these problems can be prevented with proper management of the patient’s diabetes. The healthcare provider must offer the patient with diabetes a holistic approach to their diabetes management. This means that the healthcare provider must consider all of the many health problems that the patient with diabetes may be experiencing and address all of these problems in order to manage the patient’s diabetes. According to Jaakola and Wood (2016) the approach to the management of the patient with diabetes should include an assessment of the patient’s risk for foot and related problems. The healthcare provider must also provide the patient with diabetes with proper footwear and implement foot care strategies in order to reduce the patient’s risk for foot and related problems. Implementing and maintaining foot strategies is very important in the management of the patient with diabetes in order to prevent many serious foot problems.
Citations:
Udovichenko, O.V., Gorohov, S.V., Ulianova, I.N., Ermolaeva, O.S., Berseneva, E.A. and Galstyan, G.R., 2013. Total-contact cast efficacy in diabetic foot ulcers: clinical and pedographic points of view. Diabetic Foot J, 16(3), pp.115-20. https://diabetesonthenet.com/wp-content/uploads/dfj16-3-115-20-1.pdf
Serena, T.E., Bullock, N.M., Cole, W., Lantis, J., Li, L., Moore, S., Patel, K., Sabo, M., Wahab, N. and Price, P., 2021. Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial. Journal of wound care, 30(Sup5), pp.S7-S14. https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2021.30.Sup5.S7
Bellomo, T.R., Lee, S., McCarthy, M., Tong, K.P.S., Ferreira, S.S., Cheung, T.P. and Rose-Sauld, S., 2022, June. Management of the diabetic foot. In Seminars in Vascular Surgery (Vol. 35, No. 2, pp. 219-227). WB Saunders. https://www.sciencedirect.com/science/article/pii/S0895796722000163
Wang, Y., Zhou, J., Yan, F., Li, G., Duan, X., Pan, H. and He, J., 2015. Comparison of arthrodesis with total contact casting for midfoot ulcerations associated with charcot neuroarthropathy. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 21, p.2141. https://pmc.ncbi.nlm.nih.gov/articles/PMC4517922/
Abdo, R.J., 2016. Treatment of diabetic foot ulcers with dehydrated amniotic membrane allograft: a prospective case series. Journal of Wound Care, 25(Sup7), pp.S4-S9. https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2016.25.Sup7.S4
Jaakola, E. and WOOD, R., 2016. Total contact casting the charcot foot. The diabetic foot, pp.103-110. https://podiatrym.com/pdf/2016/11/Jaakola1116web.pdf
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