title: A comparison of two total contact cast constructs with variable body mass.
abstract: OBJECTIVE
  There is a growing body of evidence implicating obesity as having a negative effect on the development and treatment of diabetic foot disease. The aim of this study was to increase the body of knowledge on the effects of obesity on foot function, specifically as it relates to peak plantar pressures in the total contact cast (TCC). Our investigational objectives were to compare the effect of two different TCC designs on mean peak plantar pressures, and to evaluate the efficacy of two TCC constructs with increasing body mass.
  
  
  METHODS
  The primary outcome measure was mean peak plantar pressure in the heel, midfoot, forefoot and first metatarsal as measured with an in-shoe pressure measurement system. The variables were patient weight (from 'normal' body mass index (BMI) to 'overweight', 'obese' and 'morbidly obese') and the TCC construct (with both a standard and alternate cast design). The standard TCC is considered the gold standard for off-loading of the diabetic foot. The alternate TCC was designed to use the essential offloading component of the traditional TCC, namely the total contact leg section, with use of an open cell polyurethane foam to transfer load from the foot to the lower leg, thereby offloading the foot by suspending it within a padded fiberglass walking cast.
  
  
  RESULTS
  We did not observe statistically significant differences in mean peak plantar pressures in any plantar foot anatomic area or with any body mass between the two TCC designs.
  
  
  CONCLUSIONS
  Based on the results, we concluded that the alternate TCC design provides another viable TCC construct option for practitioners working with the neuropathic foot. This investigation also provides specific data on changes that occur in peak plantar pressures with use of the total contact cast and variable BMIs.
  
  
  BACKGROUND
  none.
authors.affiliation: Chief Resident, Temple University Hospital Podiatric Surgical Residency Program, Temple university Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Pirozzi
authors.forename: James
authors.initials: J
authors.lastname: McGuire
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meyr
keywords: TCC; diabetic foot; limb load cast; obesity; suspension cast