Podiatric intervention in the management of a diabetic foot ulceration: a case study using total contact casting
AbstractAn understanding of the key elements of the cause of diabetic foot ulcerations is critical to enable comprehensive care for such patients. Identification of associated challenges is also essential in order to implement effective care. The management of diabetic foot ulcerations can be very challenging for both the health professional and the patient. Lack of resources and appropriate wound care skills may impact on the ability to achieve wound healing successfully. It is also crucial that management encompasses an interdisciplinary team to provide holistic care for the patient. This article shows that only a few members of different healthcare disciplines needed to work together to provide effective care. The reduction and redistribution of peak plantar pressures, in combination with ulcer debridement, is key to the management of diabetic foot ulcerations. Unfortunately, decisions that are taken in clinical practice vary widely as to which device to use when offering wound pressure offloading. This is despite the fact that total contact casting (TCC) is regarded as the gold standard in the offloading of noninfected neuropathic ulcerations. The consensus is that TCC is underused in the South African wound community. Other offloading devices, such as felt paddings or shoe inserts, are used primarily. This article seeks to demonstrate that in South Africa, TCC should be considered as a primary offloading device if there are no contraindications, such as impaired circulation or infections in the wound.
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