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Evaluating Iatrogenic Complications of the Total-Contact Cast

An 8-Year Retrospective Review at Cleveland Clinic

Tammy M. Owings Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.

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Nicole Nicolosi Department of Podiatry, Mercy/HealthSpan Foot and Ankle Residency, Parma, OH. Dr. Nicolosi is now with the Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.

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Jessica M. Suba Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH.

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Georgeanne Botek Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.

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Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications.

Methods: The largest retrospective review to date of iatrogenic complications of total-contact casts was conducted over an 8-year period at Cleveland Clinic.

Results: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation. Of these complications, 92.1% resolved, 6.4% were lost to follow-up, and 1.4% resulted in a partial foot amputation. Mean cast duration was 10.3 days for patients who developed a total-contact cast iatrogenic complication. The most common indication for the use of a total-contact cast was a neuropathic foot ulceration.

Conclusions: The results of this study support the use of total-contact casting in the insensate patient with diabetes. However, adequate staff training in total-contact cast application is recommended to reduce complications.

Corresponding author: Nicole Nicolosi, DPM, Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH. (E-mail: nicolosin14@gmail.com)