diabetic foot ulcer treatment priorities · issue #1: cast is too long problems with this cast: -...
TRANSCRIPT
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Diabetic Foot Ulcer Treatment Priorities:
Vascular Status Infection control
Wound DebridementOff-Loading/
Pressure Relief
Blood Glucose
Control
Patient Education/
Compliance
Wound Environment
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Neuropathic Foot Ulcers
Pre-ulcerative conditions
Post-operative care
Charcot Neuroarthropathy
Debridement Adequate Vascular Supply Infection Control
Total Contact Cast Application
•The Cast is loose, rubbing or pistoning; causing
pain; gets wet
•The Patient has fever, chills, nausea, vomiting or
claustrophobia
YES → REMOVE THE CASTNO → Cast Change in 2-3 Days
Reassess prior to reapplication Charcot Neuroarthropathy
Change Cast Weekly to Bi-Weekly
Forefoot Ulcers
Change Cast Weekly
Midfoot/Rearfoot Ulcers
Change Cast Twice Weekly to Weekly
Continue Casting for Two Weeks After
Ulcer is Healed
Guidelines for the Management of a Patient
with Neuropathic Foot Complications
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How Does It Work?
•Shorten stride length•Eliminating propulsive phase of gait•TCC decreases plantar pressure by up to 69%1
•Full contact with weekly custom fit cast provides control of shear•Ensures 100% compliance
Wertsch, et al, Plantar Pressures with Total Contact Casting. Jrnl Rehab Rsch & Dev , 32:3;205-209, 1995.
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MISAPPLIED CASTS
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Issue #1: Cast is too long
Problems with this cast:
- Lose the “peg in hole” effect of TCC- Can impact peroneal nerve, which may
lead to foot drop- Stretching the cast may weaken the
strength
Recommendation: Remove and re-apply with proximal edge ending at widest part of the calf muscle
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Issue #2: Cast is too short
Problems with this cast:
- Lose the “peg in hole” effect of TCC- Paddle system will reach above proximal
edge of cast- Ineffective at pressure reduction
Recommendation: Remove and re-apply with proximal edge ending at widest part of the calf muscle
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Issue #3: Cast is not complete
Problems with this cast:
- Open toe can allow unwanted articles to enter into the cast
- Toes are not protected from impact while walking
Recommendation: Remove and re-apply with distal end folded over toe area.
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Issue #4: Cast is not at 90 degrees
Problems with this cast:
- Most common error- Plantar flexed cast will crack at ankle
joint over time- May cause pressure points around the
ankle
Recommendation: Remove and re-apply with ankle at 90°
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Issue #5: Dirty Plantar Surface
Problems with this cast:
- Key sign that the patient is not wearing their boot
- May lead to cast breakdown over time- Reduces offloading effect of system
Recommendation: Re-educate the patient and family around the importance of wearing the boot at all times
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Issue #6: Tight Around the Toes
Problems with this cast:
- Bound toes can lead to additional ulcer development on toes or worse if unchecked
Recommendation: Remove and re-apply cast, leaving adequate space for toes (2 finger breadths between toes and padding)
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WHEN PATIENT IS TOO LARGE OR
FOOT TOO DEFORMED…
MEDE-KAST ULTRA IS READY!
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• Prep1
• Roll2
• Apply3
MedE-Kast
ULTRA
Application
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MedE-Kast ULTRA
Application
Prep Apply Primary Dressing
using paper tape
Apply Stockinette up to knee
fold over toes, tape, cut excess
Apply Tibia/Maleolar Pad
secure maleoli first
Apply Grey Toe Foam
start at sulcus of toes and fold
cut excess at each side
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Roll Roll Patient to Prone
bend knee and ankle to 90˚
Roll Cast Padding
use 2-3 pieces across tibia and dorsum of foot to help removal
Roll Plaster Layer
Wet plaster & roll from toes to calf
stop at widest point of calf
Roll Fiberglass Layer
Wet 3” fiberglass and roll from toes to calf – stop just before plaster edge
MedE-Kast ULTRA
Application
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Apply
Apply first splint
Apply splint from calf – overhang toes
– cut & fill into arch-cut at heel
Apply Grey Foot Plate
place on flat surface of foot
Apply Green Walking Peg
align center cut of peg with tibia
Apply 2nd Fiberglass Splint
Fold splint 1/3 and cut about 3”-4”
apply over walking peg – fold proximal edge
Apply Final Roll of 4” Fiberglass
Wet & roll enclosing toes to complete cast
MedE-Kast ULTRA
Application
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• Identify Padding1
• Cut with Cast Saw2
• Remove Internal Layers3
MedE-Kast
ULTRA
Removal
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MedE-Kast ULTRA Removal
Identify padding along tibia, maleoli
and toes
Identify placement
of cast saw cuts on padding
Five cuts
Two sagittal anterior
Two oblique malleolar
One distal transverse
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Cut cast on padding
Five cuts
Two sagittal anterior
Two oblique malleolar
One distal transverse
MedE-Kast ULTRA Removal
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Remove padding along tibia to
dorsum of foot
Remove stockinette with
bandage scissors cut along tibia
Remove foot from cast
MedE-Kast ULTRA Removal