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OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02).
CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
Hi,
I was wondering if anyone could let me know what material the 'cohesive bandage' was that was used in this study. Would a layer of fiberglass work as this cohesive bandage.
I am very interested to know as we have several pt's we would like to try this technique on.
Thanks.
Looks as if Scotchcast or fibreglass bandage would do fine.
I haven't tried this yet and I like the idea. What about simply wrapping a couple of layers of bandage around the straps, rather than bulking out the whole Air Cast? Would fibreglass bandage adhere too much to the air cast?Regards to all from Sunny Ayrshire, Scotland.
John
A Cohesive bandage is a specialty bandage which sticks only to itself, and can be peeled of with no special equipment. Commonly used as the outer layer of leg ulcer dressings eg S&N Profore* Four Layer Compression Bandage System For Leg Ulcer Management.
It is available from many medical suppliers and for a picture see below. Comes in many different colour, including skin tone
__________________ Stephen Tucker Eastern Health
Podiatry Manager
One may, frankly, use whatever one wants to when converting a removable cast walker (RCW) to an irremovable one.
After preparing the foot (in a similar fashion to a TCC-- see www.diabetic-foot.net for details) We tend to initially use coban (cohesive bandage), wrapped over the entire RCW (usually either a DH Walker or Aircast Diabetic Walker). We then have the patient back in two days to evaluate for any irritation. If there is any irritation, we may pad the area with cotton padding (webril/cast padding). We then have the patient back weekly.
Cheers,
DGA
David. G. Armstrong
Professor of Surgery
Chair of Research and Assistant Dean
Dr. William M. Scholl College of Podiatric Medicine at
Rosalind Franklin University of Medicine
I was wondering if anyone knew if there has been any thought or development into removable cast walkers with a locking mechanism attached, so pts were unable to remove the walker themselves?? It would be doing much the same as the cohesive bandage with less time and resourses needed.
Its an idea which im sure other people have already thought of.
At the end of the day:
1. Biomechanical/lab studies have shown the removable cast walkers to be just as effective as TCC in reducing plantar pressures
2. Research has shown the TCC to be more effective clinically than the reemovable walker (eg here)
3. Compliance with the use of the removable walker has been show to be very bad (which could account for the paradox between (1) and (2) above)
4. If the removable walker can be made nonremovable (by whatever means), then (3) is addressed and (2) may change - and its cheaper and quicker to apply.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Admin : 10th March 2005 at 02:13 AM.
Removable and irremovable cast walkers
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