Demonstration of Healing with a Roll On Contact Cast System in Charcot Foot Patients with Complicated Medical Histories and High Risk of Amputation

Problem: Charcot foot  is a serious, potentially limb-threatening complication of diabetes.1 Immediate immobilization of the lower limb and the redistribution of its plantar forces, which are accomplished with a conservative therapy such as total contact casting (TCC), remain gold standard methods of preventing further breakdown of the joint in the presence of Charcot foot.2 However, TCC remains underutilized. Here, we present 3 Charcot foot ulcers that were at risk of amputation and successfully managed using a roll on contact cast system (……TEZ ).

Materials and Methods: Three diabetic patients with Charcot foot deformities and associated ulcers presented at the wound care clinic. Patients had comorbidities included  but not limited to poorly-controlled diabetes, morbid obesity, diabetic peripheral neuropathy, hypertension, coronary artery disease, chronic obstructive pulmonary disease and human immunodeficiency virus infection. All wounds were debrided and treated with collagen dressings. In one case, Dermagraft was  applied as well. When the patients’ wounds continued to progress to the point that amputation was the next option, TEZ  was applied.

Results: All 3 Charcot ulcers showed significant progress toward closure with TEZ . In the first case, a 1.5cm x 1.5cm x 0.3cm wound healed within 35 days of TEZ application; the second ulcer, which measured 2.1cm x 3.0cm x 0.5cm at TEZ initiation, healed within 66 days and the final 2.3cm x 1.5cm x 0.3cm wound reached 98% closure at the time that the abstract was submitted.

Conclusions: The presented cases illustrate that good off-loading, accomplished with an easy-to-apply TEZ system, achieves wound closure despite Charcot deformity and in the presence of multiple comorbidities impairing wound healing. These cases also illustrate that physicians should be persistent in recommending TCC treatment as early as possible, to preserve the limb and prevent wound recurrence.

Trademarked Items (if applicable): TEZ = TCC-EZ ® Total Contact Cast System, Integra LifeSciences Corp., Princeton, NJ

References (if applicable): 1. Varma AK. Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg. 2013;52(6):740-749.
2. Güven MF, Karabiber A, Kaynak G, Ögüt T. Conservative and surgical treatment of the chronic Charcot foot and ankle. Diabetic Foot Ankle. 2013;4:21177.