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Technique for Fabrication of an “Instant Total-Contact Cast” for Treatment of Neuropathic Diabetic Foot Ulcers

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  • 1 Director of Research and Education, Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson; Visiting Senior Lecturer, Department of Medicine, Manchester Royal Infirmary, Manchester, England. Mailing address: Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, 3601 S Sixth Ave, Tucson, AZ 85723.
  • | 2 Submitted during second-year residency, Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson.
  • | 3 Attending Physician, Diabetic Foot Center, Providence St Joseph Medical Center, Burbank, CA.
  • | 4 Chief, Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson.
  • | 5 Professor, Department of Medicine, Manchester Royal Infirmary, Manchester, England.
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Addressing pressure reduction in the treatment of diabetic foot wounds is a critical component of therapy. The total-contact cast has proven to be the gold standard of treatment because of its ability to reduce pressure and facilitate patient adherence to the off-loading regimen. Removable cast walkers have proven to be as effective as total-contact casts in pressure reduction, but this has not translated into equivalent time to healing. A simple technique to convert the removable cast walker into a device that is not as easily detached from the lower extremity, thereby encouraging the use of this device over a 24-hour period, is presented in this article. The procedure involves wrapping the cast walker with cohesive bandage or plaster of Paris. In the authors’ opinion, this technique addresses many of the disadvantages of the total-contact cast, resulting in an adequate compromise in this aspect of care. (J Am Podiatr Med Assoc 92(7): 405-408, 2002)