Originally Posted by K Harris
I am now fortunate to be working in a Trust where Total Contact Casting is available for patients with diabetic foot ulceration. Whilst I’m aware that this is often quoted as “Gold Standard” it appears that on a practical basis patient selection and mode of application varies even amongst neighbouring areas. Our Diabetic Foot Team is keen to explore how we can ensure we are selecting the right pts for casting, identifying the known risks in order that we can ensure the patient is giving informed consent to casting etc. With that in mind is anyone able to point me in the direction of some definitive answers eg:
TCC is contra-indicated if patient has ischaemia – but what measure should be used for this – clinical presentation? monophasic pulses? ABPI’s – if so at what value?
Has anyone got a policy or set of guidelines that they currently use?
Has anyone got a patient advice leaflet for contact casting for DFU?
On a practical note quite a number of pts seem to clunk their other foot with the cast – does anyone issue any cover/silicone sock etc as a prevention?
Any other helpful comments would be gratefully received.
Diabetes Lead Podiatrist
Bristol Community Health
I am working with a MDF Team that does do TCC where indicated either for active Charcot foot or chronic neuropathic ulceration.
have a good set of criteria is important we find eg with chronic ulcers a wound that is not infected, wound must be wider than it is deep and not tracking deeper.
Compliance is a key factor, distance form the clinic, ischemia is a contra indication we use toe pressures Under 40 mmhg is our cut off point. Skin fragility, oedema or volume changes, stability with a cast is another consideration, home enviroment may be an issue if they have alot of steps.
if we cast a client we will go through with them what is involved in TCC and have a pre evaluation.
if a wound is involved we will cassify it using the Texas wound classification system, measure the size and photograph the wound, all this information is documented in the casenotes.
casting changes are weekly to begin with as there is often a lot of shrinkinge in the cast limb. we then extend the casting change to every two weeks. at each cast change the wound is reviewed measured to evaluate progress.
We tend not to cast beyond a three month peorid due to muscle weakness and the potential of bone density loss.
if there is a Charcot foot collapse there are some medications that can help with bone deposition,but this is more the field of our endocrinologist.
Post TCC the client is usally in either a diabetic walker or a CROW initally and then into custom footwear with a total contact insole with regular reviews. this is of course depandant upon the foot and deformity if present.
hope this is useful