TOTAL CONTACT CASTS - PRESSURE REDUCTION AT ULCER SITES AND THE EFFECT ON THE CONTRALATERAL FOOT

Objective: To compare the effectiveness of total contact casts with a cast boot (TCCB), total contact casts with a cast heel (TCCH) and ther apeutic XtraDepth(R) shoes (XDS) to reduce ulcer site pressures and to determine if total contact casts increase contralateral pressures. De sign: Repeat measure design with 40 replications nested within each tr eatment for each patient. Methods: Peak contralateral foot pressures a nd ulcer site pressures under the 1st metatarsal (1MET; n = 10), 2nd t o 5th metatarsals (2-5MET; n = 10), and great toe (GT; n = 5) were com pared using the Novel-Pedar system and three treatments: TCCB, TCCH, a nd XDS. Baseline pressures were established using canvas oxfords. Resu lts: There was no difference in pressure reduction with TCCH vs. TCCB for 1MET or GT ulcers, but TCCH reduced pressure better for 2-5MET ulc ers (p < .001). Contralateral pressures were not elevated in either TC C group. Conclusions: TCCH were superior to TCCB in reducing 2-5MET ul cer pressures and equivalent to TCCB for 1MET and GT ulcers. Contralat eral pressures are not increased by TCC use. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physic al Medicine and Rehabilitation.