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Alternative Technique for Healing Chronic Foot Ulcers

This presentation discusses an alternative technique for off-loading pressure in foot ulcers, including the use of soft offloading bandages. The benefits and appropriate applications of Total Contact Casting (TCC) are also examined.

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Alternative Technique for Healing Chronic Foot Ulcers

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  1. Foot ulcers: A different technique to total contact casting for healing chronic foot ulcers Maria Shaw. NZRN CNSL ORTHOPAEDICS PG. Cert Advanced Nurse Practice/Orthopaedics PG. Cert Clinical Management

  2. AIMS of Presentation Present an alternative technique to off-loading pressure for foot ulcers

  3. OBJECTIVES • Identify when it’s appropriate to apply TCC • Understanding the principles of an alternative offloading technique for foot ulcers • Understand the principles of applying soft offloading bandage

  4. Total Contact Casting (TCC) is considered the gold standard (Jensen et al 2008) • Numerous studies • Alternative methods to achieve the same results

  5. VENOUS (vascular) ULCERS Varicose ulcer also known as stasis ulcer Ulceration due to vascular causes often are both arterial & venous disease

  6. NEUROPATHIC(Nerve) ULCERS Neuropathic ulcers foot has loss of sensation Exerts pressure at one spot The Edge Effect (Armstrong DG, Athanasiou KA) Two distructive forces shearing and vertical stress

  7. Increased plantar foot pressure • Offloading • Debriding (Armstrong DG, Lavery LA, et al)

  8. WHY CONSIDER AN ALTERNATIVE OFF LOADING TECHNIQUE • TCC can be POP or Synthetic cast • TCC not suitable for some patients • Use with caution • Noncompliant patients • An experienced cast technician or physician should apply the TCC.

  9. MOONBOOT & DARCO SHOE

  10. Case Study 1

  11. Case Study 1 • 38 year Old Man with Alport’s Syndrome (hereditary disease that causes nephritis accompanied by deafness & eye problems) • Type 2 Diabetic • Ulcer to the planter of his right foot • Ulcers to the lateral malleolus on his left ankle

  12. Case study • 38 year Old Man with Alport’s Syndrome (hereditary disease that causes nephritis accompanied by deafness & eye problems) • Type 2 Diabetic • Ulcer to the planter of his right foot • Ulcers to the lateral malleolus on his left ankle

  13. Malleolus pressure sore & Chronic foot ulcer

  14. TECHNIQUE FOR SOFT OFFLOADING BANDAGE Plaster stocking from foot to kneeSoffban x 4 rollsCrepe bandagesMoonboot or DARCO Shoe

  15. Not all patients are going to benefit from this process. Patients will need to be risk assessed for possible application of Offloading techniques including TCC They need to understand and be compliant with the process to ensure a good outcome.

  16. REFERENCES • Armstrong DG, Athanasiou KA. The edge effect: how and why wounds grow in size and depth. Clinical Podiatry Med Sur. 1998: 105-108 (PubMed) • Armstrong DG, Lavery LA, et al. It is not what you put on, but what you take off: techniques for debriding and offloading the diabetic foot wound. Clin Infect Dis. 2004:39:S92-9. (PubMed) • Armstrong DG, Nguyen HC, Lavery LA, Van Schie CH, Boulton AJ, Harkles LB. Offloading the diabetic foot wound. Diabetes Care. 2001: 24(6):1019-1022 • Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719–1724. (PubMed) • Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev. 2010;(1):CD003556. [PubMed] • Espensen E. Assessing Debridement Options For Diabetic Wounds. Podiatry Today. March 2007:20(3) • Fard AS, Esmaelzadeh M, Larijani B. Assessment and treatment of diabetic foot ulcer. Int J Clin Pract. 2007;61:1931–1938. (PubMed) • Fife C, Carter M, Walker D. Why is it so hard to do the right thing in wound care?. Wound Repair & Regeneration [serial online]. March 2010;18(2):154-158. • Joakola E, Weber A. Current concepts In total contact casting for DFU’s.\, 2014; 27(4) Podiatry today • Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.:CD002302. DOI: 10.1002/14651858.CD002302.pub2. • Lindy Begg L, Burns J, Fletcher J, McLaughlin P, Vicaretti. Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes. Journal of Foot and Ankle Research 2015. 20169:2. • Myerson M, Papa J, Eaton K, Wilson K. The total contact cast for management of neuropathic plantar ulceration of the foot. JBJS (Am). 1992; 74:261-269.

  17. REFERENCES • Nick Martin, DPM, Tim Oldani, DPM, and Matthew J. Claxton, DPM. Podiatry today Issue Number 9 Volume 18 september 2005 • Sawacha Z, Gabriella G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C. Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis. Clin Biomech (Bristol, Avon) 2009;24:722–728. [PubMed] • Seaman S. The role of the nurse specialist in the care of patients with diabetic foot ulcers. Foot Ankle Int. 2005;26:19–26. (PubMed) • Shau S. Do Clinical and Economic Benefits of Healing Diabetic Foot Ulcers With Rigid Total Contact Cast. Wounds 2012; 24(6): 152-159 • Snyder RJ, Hanft JR. Diabetic foot ulcers--effects on QOL, costs, and mortality and the role of standard wound care and advanced-care therapies. Ostomy Wound Manage. 2009;55:28–38. [PubMed) • Wu SC, Jensen JL, Weber AK, Robinson DE, Armstrong DG, Use of pressure offloading devices in diabetic foot ulcers: so we practice what we preach? Diabetes Care. 2008: 31(11): 2118-2119 • Pictures of Diabetic Neuropathy Healthline www.healthline.com

  18. Thank you

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