title: Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot.
abstract: OBJECTIVE
  To compare the effectiveness of total contact casts with a cast boot (TCCB), total contact casts with a cast heel (TCCH), and therapeutic XtraDepth shoes (XDS) to reduce ulcer site pressures and to determine if total contact casts increase contralateral pressures.
  
  
  METHODS
  Repeat measure design with 40 replications nested within each treatment for each patient.
  
  
  METHODS
  Peak contralateral foot pressures and ulcer site pressures under the 1st metatarsal (1MET; n = 10), 2nd to 5th metatarsals (2-5MET; n = 10), and great toe (GT; n = 5) were compared using the Novel-Pedar system and three treatments: TCCB, TCCH, and XDS. Baseline pressures were established using canvas oxfords.
  
  
  RESULTS
  There was no difference in pressure reduction with TCCH vs. TCCB for 1MET or GT ulcers, but TCCH reduced pressure better for 2-5MET ulcers (p < .001). Contralateral pressures were not elevated in either TCC group.
  
  
  CONCLUSIONS
  TCCH were superior to TCCB in reducing 2-5MET ulcer pressures and equivalent to TCCB for 1MET and GT ulcers. Contralateral pressures are not increased by TCC use.
authors.affiliation: Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78284, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
authors.forename: S A
authors.initials: SA
authors.lastname: Vela
authors.forename: D C
authors.initials: DC
authors.lastname: Lavery
authors.forename: T L
authors.initials: TL
authors.lastname: Quebedeaux
mesh_terms: D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D003924:Diabetes Mellitus, Type 2 / Q000534:rehabilitation; D017719:Diabetic Foot / Q000534:rehabilitation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012775:Shoes