11) Total Contact Casting Flashcards
1
Q
Total contact casting
A
- Significantly reduces plantar pressures
- Ideal for neuropathic ulceration or Charcot foot
- “Gold standard” in managing neuropathic wounds
2
Q
Total contact casting historical
A
- Milroy Paul
- Paul Brand
3
Q
Total contact cast indications
A
- Wagner grade I & II neuropathic ulcers
- Midfoot lesions
- Rearfoot lesions
- Charcot arthropathy (acute, reparative)
- Concern over pt compliance, using removable cast walker or half shoe
4
Q
Total contact cast contraindications
A
- Infection
- Edema
- Severe peripheral vascular disease
- Highly Oxidative Ulcer
- Claustrophobia/non-tolerance of patient
5
Q
Advantages of total contact cast
A
- Forced compliance
- Shortens stride length
- Decrease cadence
- Reduces activity
- Reduces peak pressures
6
Q
Patient acceptance in total contact cast
A
- “Castophobia”
- Hot
- Heavy
- Disrupts Sleep
- Difficult to bathe
7
Q
Physician acceptance in total contact casting
A
- Surveillance/infection
- Expertise
- Time
- Materials
- Reimbursement
8
Q
Materials used in total contact casting
A
- Stockinette
- Lambs wool
- Adhesive Sifoam
- ¼’’ adhesive felt
- ¼” wood platform
- Gypsona plaster rolls
- Plaster splints (5’’)
- Fiberglass rolls
9
Q
Wound care considerations in total contact casting
A
- Proper debridement of necrotic or otherwise non-viable tissue
- Recent negative wound culture
10
Q
Documentation
A
- Exposed x-ray film
11
Q
Digital protection
A
- Lambs wool
- Cast padding
12
Q
Adhesive sifoam
A
- Applied directly over wound
13
Q
Felt application
A
- Protects and facilitates removal
- ¼’’ felt strip applied to anterior tibial crest
- ¼’’ felt pads applied anterior to malleoli
14
Q
Cast padding (Webril)
A
- Minimal application
- Avoid “tenting”
- Primarily applied anteriorily
15
Q
Gypsona plaster “eggshell”
A
- The most critical step
- Plaster molded with hands
- Plaster formed carefully to all contours
- Serves to transmit weight from the body to the outer layers of the cast
