Riopelle A, LeDuc R, Wesolowski M, Schiff AP, Pinzur MS, et al.
Foot & ankle specialist. Date of publication 2021 Feb 1;volume 14(1):25-31.
1. Foot Ankle Spec. 2021 Feb;14(1):25-31. doi: 10.1177/1938640019895920. Epub 2019
Dec 31.
Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders.
Riopelle A(1)(2), LeDuc R(1)(2), Wesolowski M(1)(2), Schiff AP(1)(2), Pinzur
MS(1)(2).
Author information:
(1)Loyola University Medical School, Maywood, Illinois (AR, RL, MW).
(2)Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health
System, Maywood, Illinois (APS, MSP).
The custom-fabricated total contact cast is commonly used in the treatment of
diabetic foot disorders. This resource-consuming treatment option has been
associated with iatrogenic morbidity as well as the need for urgent cast removal
and inspection of the underlying limb when potential problems arise. Over a
10-year period, 381 diabetic patients had 2265 total contact cast applications by
certified orthopaedic technologists, in a university orthopaedic practice, under
the supervision of university faculty. Patients were stratified by glycemic
control based on hemoglobin A1c levels, and obesity based on body mass index
(BMI). Complications were grouped as (1) development of a new ulcer or wound, (2)
new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly
identified osteomyelitis, and (6) pain or discomfort necessitating cast change or
removal. At least 1 complication was observed in 159 of 381 patients. The odds of
experiencing a cast-related event for patients with a BMI greater than 30 kg/m2
was 1.55 times greater than patients with a BMI less than 25 kg/m2. As compared
to patients with good glycemic control, the odds of experiencing a
cast-associated complication was 1.27 times greater in patients with moderate
glycemic control and 1.48 times greater in patients with poor glycemic control.
The total contact cast is commonly used in the treatment of diabetic foot
morbidity. Treatment-associated morbidity may well be greater than previously
appreciated. Complications are more likely in patients who have poor glycemic
control and are morbidly obese. This information will hopefully stimulate
interest in developing commercially available nonrigid alternatives that retain
the attributes of the resource-consuming rigid device, with the potential
advantage of avoiding the associated morbidity.Levels of Evidence: Level IV,
retrospective chart review.
DOI: 10.1177/1938640019895920
PMID: 31888384 [Indexed for MEDLINE]
