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. 2022 Jan;16(1):137-143.
doi: 10.1177/1932296820964069. Epub 2020 Oct 23.

Ventral Windowed Total Contact Casts Safely Offload Diabetic Feet and Allow Access to the Foot

Dirk Hochlenert  1 , Claudia Fischer  2
Affiliations

Ventral Windowed Total Contact Casts Safely Offload Diabetic Feet and Allow Access to the Foot

Dirk Hochlenert et al. J Diabetes Sci Technol. 2022 Jan.

Abstract

Background: Irremovable total contact casts (TCCs) are the gold standard to offload diabetic foot ulcers (DFUs) and to immobilize feet with active Charcot neuro-osteoarthropathy (CN). They do not allow checks of the foot and are contraindicated in people with peripheral arterial disease (PAD). Frequently, removable TCCs and other removable devices are used because they allow wound care, modifications of the inner surface of the cast, and checks of the foot. The authors propose TCCs with ventral windows (VW-TCCs) whenever patients with high-risk conditions show poor adherence to wearing a removable cast all the time and access to the foot is necessary.

Methods: This retrospective study compares treatments with bivalved, removable TCCs applied prior to the introduction of the novel design (from 1 January 2016 to 1 July 2017, "c") to treatments in the following period (t) with both bivalved removable TCCs and VW-TCCs in use.

Results: Forty-five treatments after introduction (17 with the VW-TCC) showed a 52.8% lower median time to reach remission of the DFS than 41 controls (128/267 days, log-rank test P = .013). Reasons given for not using the novel design were: sufficient offloading with a removable TCC (16), patient preference (six), anatomical conditions (two), casts applied as a service for other facilities (three), and calf ulcers (one). Adverse effects from both designs were uncommon and not severe.

Conclusions: VW-TCCs combine advantages of both removable and irremovable TCCs. Complications do not limit the use, even in patients with PAD.

Keywords: Charcot foot; diabetic foot; diabetic foot ulcer; total contact cast; ventral window.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ventral windowed total contact cast (VW-TCC): (a) closed with Velcro straps and sole applied; (b) opening and closing of the window; (c) optimized for heel ulcer; (d) optimized by additional lid at the calf.
Figure 2.
Figure 2.
Time to remission from the begin of the use of the TCC. The green line denotes the treatments in the control period, the yellow line denotes the treatments after the introduction of the VW-TCC, using both types of TCC. A cross is used to mark censored cases due to the end of the observation period. TCC, total contact cast; VW-TCC, total contact cast with ventral window.
See this image and copyright information in PMC

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