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Is TCC-EZ a Suitable Alternative to Gold Standard Total-Contact Casting?

A Plantar Pressure Analysis

Umangi K. Bhatt DPM, Hui Ying Foo DPM, Mahalia P. McEvoy DPM, Sarah J. Tomlinson DPM, Cara Westphal BSc (Podiatry), Jessica C. Harrison BSc (Podiatry), Olufemi Oshin MD, FRCS (Eng), and Sarah L. Carter PhD
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Background

The total-contact cast (TCC) is the gold standard for off-loading diabetic foot ulcers (DFUs) given its nonremovable nature. However, this modality remains underused in clinical settings due to the time and experience required for appropriate application. The TCC-EZ is an alternative off-loading modality marketed as being nonremovable and having faster and easier application. This study aims to investigate the potential of the TCC-EZ to reduce foot plantar pressures.

Methods

Twelve healthy participants (six males, six females) were fitted with a removable cast walker, TCC, TCC-EZ, and TCC-EZ with accompanying brace removed. These off-loading modalities were tested against a control. Pedar-X technology measured peak plantar pressures in each condition. Statistical analysis of four regions of the foot (rearfoot, midfoot, forefoot, and hallux) was conducted with Friedman and Wilcoxon signed rank tests. Significance was set at P < .05.

Results

All of the off-loading conditions significantly reduced pressure compared with the control, except the TCC-EZ without the brace in the hallux region. There was no statistically significant difference between TCC-EZ and TCC peak pressure in any foot region. The TCC-EZ without the brace obtained significantly higher peak pressures than with the brace. The removable cast walker produced similar peak pressure reduction in the midfoot and forefoot but significantly higher peak pressures in the rearfoot and hallux.

Conclusions

The TCC-EZ is a viable alternative to the TCC. However, removal of the TCC-EZ brace results in minimal plantar pressure reduction, which might limit clinical applications of the TCC-EZ.

School of Allied Health, The University of Western Australia, Crawley, Australia.

Royal Perth Hospital, Perth, Australia.

Corresponding author: Sarah L. Carter, PhD, School of Allied Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia (E-mail: sarah.carter@uwa.edu.au).

Conflict of Interest: None reported.