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The pros and cons of various Casting options for diabetic feet

We use Total Contact Casts, Slipper casts, and pneumatic walkers at our clinic.

Total Contact Casts

Advantages:

  • Provide good pressure relief for ulcers.
  • Provide stability for Charcot joints.
  • Effective for use on "non-compliant" patients who might otherwise remove the splint and not wear anything on their foot.

Disadvantages:

  • Not suitable for the elderly patients as they can find walking with them makes them unstable.
  • Not suitable for use in the bathroom. The steam can soften the Plaster of Paris, so should not be used in a shower or bath even when covered in a waterproof cover.
  • Cannot be used for longer than 3 weeks because due to the reduction in swelling of the leg the cast becomes loose and this can be dangerous.
  • More expensive than pneumatic walkers (approx. £275 including the dressing costs)
Total contact cast
 

Pneumatic Walkers

Advantages:

  • Light and easy to keep clean.
  • Patients generally prefer them to the plaster cast.
  • Can be removed for bathing and sleeping.
  • Good for active Charcot feet.
  • More suitable for frequent dressing changes.
  • Suitable for vascular patients and where swelling is present.
  • Cheaper than Total Contact Casts (approx. £150 including dressing changes)

Disadvantages:

  • No good for non-compliant patients
  • No good for oversize patients - a TCC or slipper casts are more suitable for those.

Aircast boot

Slipper casts

Advantages:

  • Suitable for elderly patients
  • Suitable for toe ulcers and forefoot ulcers
  • Can be used when other types of cast cannot be used
  • Can keep ulcers healed whilst waiting for special diabetic shoes to be made.
  • Can be made removable for dressing changes

Slipper cast

How to make a removable slipper cast



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