Total Contact Cast Offloading – Real Treatment For All Plantar Based Wounds

Kyle Hamblen DPM

Patient is a 49 year old male with a history of Charcot Marie Tooth Disease (CMT) who presented with a a plantar ulcer of the Left Foot. CMT is an inherited neuropathy which directly damage nerves fibers resulting in both sensory and motor neuropathy causing significant foot deformities. His medical history included an unknown type of reconstructive surgery to the left foot in 2007 for his CMT. The presenting plantar ulcer had been there for 7 months and treated continuously by a local podiatrist with Iodine dressings only. The patient had never been prescribed any offloading devices and presented wearing canvas sneakers. Our Initial treatment consisted of aggressive debridement of the ulcer to 100% bleeding surfaces including all skin margins. Hemostasis was achieved rapidly using Scion CLO-SURPLUS PADTM Chitosan Hemostatic dressing. M-Med's Mobility Series Total Contact Cast Kit was used to allow for modification for his unusual foot configuration. He underwent total contact casting weekly with complete healing in 5 weeks. The multi-component TTC system allowed for modifications by adding, subtracting or modifying components for the desired fit needed at that time. He was placed in a custom molded shoe with inserts and has had no recurrence to date.

Total Contact Casting is considered the Gold Standard for treatment of plantar based diabetic, neuropathic foot ulcers. While neuropathy sets the stage for the development of these tissue injuries, the definitive cause is repeated trauma and pressure to a specific area. The key to healing is to provide offloading at the point of maximum pressure and equilibrate the pressure over the entire surface. Since feet come in many sizes and shapes with each patient having different tolerances to weight, and placement of the cast, the ability to individualize the cast for each patient and their condition is of paramount importance.

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