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VINAYA. A.S.
Clinical Podiatrist&
Co - ordinator Foot ClinicBhagwan Mahaveer Jain Hospital
BangaloreKarnataka
INDIA
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Effective, rapid & ambulatory therapy for
HEALING
Diabetic neuropathic plantar ulcer
(CAST APPLICATION)
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• Benefits – Shortens the period of healing by off
loading– Shortens bed - rest in the hospital– Reduces the cost of dressing– Prevents other complications
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• In practice from the 1930s
• Started with Hansen’s disease
• To treat neuropathic plantar ulcerations
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• TCC reduces peak plantar pressures
• It increases the surface area of the foot for forefoot and mid - foot
• It allows pedal ulcers to heal rapidly
• Healing time with TCC is 36 to 43 days approximately
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• Indication for TCC
GRADE 1 & GRADE 2
plantar ulcerations in the presence of insensitivity
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• Contraindication for TCC– Active or acute deep infection– Ulcer depth greater than ulcer width– Excessive leg or foot swelling– Patient unwilling to have cast on
extremity
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• Contraindication for TCC– Patient unwilling to comply with follow
up visits or wearing precautions– Patient unsafe in mobility while in cast– Depends on doppler pressure
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• Advantages– Maintains the ambulations– Reduces excessive plantar pressures– Protects foot from further trauma– Immobilisation helps localise & prevent
the spread of infection– Controls oedema– Requires minimum patient compliance
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• Disadvantages– Impairs mobility (walking,performing basic
and instrumental activities of daily living, balance, co - ordination)
– Joint Stiffness– Muscle atrophy - if immobilisation is
prolonged– Skin abrasions– New ulcerations if cast is poorly applied– poor monitoring (foul odour due to
drainage)
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• Cast Application– Trace the ulcer– Cover it with thin dressing– Foam covering for bony prominences– Cover the bony prominences with first
layer of cast – Cover medial,lateral,posterior and
plantar walls of the cast– Wait for 24 hours to allow the inner
layers to thoroughly set.
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Instructions to Patients• Inform podiatrist in case of :
– Any swelling– Cast is tight– Loosening or excessive mobility of the
foot in the cast– Drainage on the outside of the cast– Deep cracks or soft spots in the cast– Sudden tenderness on the inguinal lymph
nodes
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TCC is the “Gold Standard” among the methods used to heal
“Diabetic Foot Ulcers”
Supports
• Numerous clinical reports
• One controlled clinical trial over the
past 25 years
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TCC and other off - loading methods remain the “corner - stone”
for healing
“pedal ulcers”
TCC may be used in conjunction
with other methods
