A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy

Ali Ersen, Lawrence A. Lavery, Aakshita Monga, Mike Richardson, Brandy Schwarz, Myles U. Quiben, Alan G. Garrett, Mike Flyzik, Dane K. Wukich, Metin Yavuz

Research output: Contribution to journalArticle

Abstract

The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P =.0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P =.0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P =.0228, Cohen’s d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P =.0532, Cohen’s d =.48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

Original languageEnglish
JournalInternational Journal of Lower Extremity Wounds
DOIs
StateAccepted/In press - 1 Jan 2020

Keywords

  • diabetic foot ulcers
  • gait speed
  • offloading
  • plantar pressures

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