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Case Series/Study
Total Contact Casting (TCC) is the gold standard for diabetic foot ulcers. Other methods of offloading include removable cast walkers, peg shoes and offloading forefoot shoes. For specific patients these alternate products are a noncovered item or are ineffective. Pressure redistribution with felt, peg inserts, offloading shoes or removable cast walkers demonstrated minimal effectiveness when observed in specific patients using advanced wound care. Bivalve (half) casting provides the effects of TCC while allowing for ease of removal for dressing changes.
Methods:
Four case study’s included bivalve casting as management for diabetic foot ulcer offloading on patients with neuropathic ulcers Wagner grade one or two. Bivalve casting was maintained over a period of between 50 and 100 days. Weekly wound clinic visits occurred reusing the bivalve cast. Home health services could remove the cast, change the dressing, and reinsert the foot and lower leg back into the bivalve cast.
Results:
Neuropathic ulcer volume significantly decreased. Case study one: resolved two wounds within 50 days, decreased volume by: wound one of 0.6 square centimeters (sq. cm) and wound two 0.25 sq. cm’s. Case study two: over 100 days two wounds decreased volume: wound one of 5.223 sq. cm’s; wound two 19.434 sq. cm’s. Case study three: resolved three wounds over 81 days decreased volume by 0.375 sq. cm; 4.68 sq. cm; 1.44 sq. cm, respectfully. Case study four: two wounds over 41 days decreased volume in wound one by 0.076 sq. cm and wound two by 0.027 sq. cm.
Discussion:
Reduction in wound volume occurred utilizing reusable bivalve casting for specific patients. The removable TCC allowed collaborative care with home health services, decreased financial burden through cost reduction of supplies while achieving wound healing. Further study is warranted.