oa Wound Healing Southern Africa - Total contact casting : a South African approach to offloading the diabetic foot : case study
Foot ulceration is the most common complication associated with those living with diabetes. Total contact casting (TCC) is regarded as the gold standard offloading method in aiding rapid healing of neuropathic plantar foot ulcers, and numerous studies and papers indicate its effectiveness. Several TCC methods are used worldwide, the most well-known being the application of TCC with plaster bandage, as described by Levin and O' Neal.However, TCC is still under-used in South Africa, and other offloading devices, such as felt padding of shoe inserts, are primarily used. The reasons for this have been discussed by the authors and healthcare professionals working in this area and, anecdotally, it appears that the most common reason for not using TCC seems to be 'fear of failure'; health professionals are uncertain how to apply TCC and are worried that it will cause more harm than good. It is, therefore, clear that guidance, education and skills training are needed to change this perception in South Africa. Several studies have shown that TCC in skilled hands is safe for the patient. Howard described the use of the Scotchcast? (3M), which has been widely adopted in South Africa. The purpose of this article is to demonstrate why and how the authors, working from two independent outpatient centres that treat patients with diabetic foot ulcers in South Africa, introduced a new TCC system, to meet the needs of the South African patient group.
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