Caroline Fife, CMO at Intellicure, investigated diabetic foot ulcers.

Those who are treating diabetic foot ulcers should evaluate modern total contact casting techniques, according to a new analysis.

Researchers led by Caroline Fife, M.D., looked at a wound care registry with 11,784 patients with more than 25,000 diabetic foot ulcers. Outcome measures studied included whether the ulcers were healed/not healed, amputation, percent of off-loading, percent use of total contact casting and infection rates.

They found off-loading was documented in around 2% of 220,000 visits over six years. The most common off-loading option was the postoperative shoe (37%) and total contact casting (16%). There were significantly more amputations within a year for those with diabetic foot ulcers who did not have total contact casting when compared with those who did, according to results in the July issue of Advances in Skin & Wound Care.

“Total contact casting is vastly underutilized in DFU wound care settings, suggesting that there is a gap in practice for adequate off-loading,” the authors wrote. 

TCC is touted as the “gold standard,” but believed to be underused because it requires a skilled cast technician, can be expensive, and takes significant time. Still, a 2012 study in British Journal of Community Nursing said that while there was a lack of consensus on DFU treatment, offloading “is undoubtedly paramount to successful and timely healing.”