Management of a Diabetic Foot Ulceration using Off-The-Shelf Instant Contact Casting Device: case report

Introduction:Management of chronic diabetic foot ulceration is a difficult challenge Podiatrists face. Patient compliance often hinders success and traditional total contact casting can be limiting and cumbersome for the patient, especially in the underserved population. Off-the-shelf instant total contact device is one option in place of traditional instant total contact casting.

This case study follows a patient who refused traditional total contact cast due to living situation and was placed in off-the shelf instant contact cast.

Methods and Results: A 57-year-old male with past medical history consisting of type 2 diabetes with peripheral neuropathy, chronic kidney disease stage 4 was admitted to the hospital for sepsis and subsequent bacteremia secondary to right foot abscess February 2019. He underwent bedside incision and drainage and multiple debridements during admission. He was discharged with negative pressure wound therapy with overlying skin substitute and four additional weeks of IV antibiotic therapy. Given the patient’s compliance with offloading, due to his living situation, the decision was made to place patient in an off-the-shelf instant contact casting device.

The patient was dispensed an instant contact cast boot August 2019, which included a proprietary trilaminar insert that could be manipulated to locally offload wound area. Patient was seen weekly for evaluation and wound care. At the time of application, the wound measured 1.7 x 1.2 x 0.5 cm. For the first 12 weeks the boot was restrained to the leg and foot with a locking strap consistent with instant total contact cast treatment. Due to patient’s intolerance the locking strap was removed for the remainder of therapy. At this time wound improved to 0.4 x 0.2 x 0.1cm. He remained in the boot, and after 20 weeks following initial application of the off-the-shelf instant contact casting device the ulceration had healed.

Discussion: This showcases another solution for patients unable to tolerate traditional instant contact casting. We believe that the off-the-shelf total contact casting device mimics the benefits of the traditional instant total contact cast device. The boot requires less physician encounter time, workload, and materials as well as offers patient autonomy to self-remove in an emergency.