For 30 years, the “Gold Standard” approach for offloading diabetic foot ulcers has been the Total Contact Cast (TCC). In fact, TCC is the only offloading approach for DFUs (non-Charcot) for which insurance reimbursement is available. Despite the strong evidence supporting it, the TCC has consistently been grossly underutilized; in fact, it is well documented that fewer than 10% of TCC-eligible patients are treated with this approach. (Source: https://lermagazine.com/editor_memo/the-dfu-dilemma-is-the-total-contact-cast-a-true-gold-standard)
Why is this? Contraindications, non-compliance, time consuming, physician discomfort, inadequate reimbursement, etc.
The reality is that the vast majority of patients do not receive any type of device that is clearly designed to offload their wound. In an estimated 10% – 30% of cases, patients are prescribed some sort of CAM boot, wedge shoe, offloading shoe, etc. to aid in offloading, but the data regarding the effectiveness of these approaches is sparse, and none of these are reimbursed by insurance when dispensed to treat a DFU.
In the latest research studies, ActivArmor’s new AFO walking-boot has better off-loading test results compared to that of the total contact cast for patients with Charcot Foot. This gives those patients with diabetes or wound issues a hygienic option for redistributing weight and reducing the pressure away from wounds. The most recent study was performed with the assistance of David Shofler, DPM MSHS Assistant Professor, Podiatric Medicine, Surgery, & Biomechanics Western University College of Podiatric Medicine, Pomona, California. Dr. Shofler held a key role in not only assisting with the boot design but also with testing. Using a Tekscan pressure testing insole, an ActivArmor 3D printed AFO was tested, along with a traditional CAM walker.
The image to the right shows maximum plantar pressures, with the results from the CAM walker on the left-hand side and the results from the ActivArmor cast on the right. With red areas indicating higher pressures, the image reflects that the forefoot pressures were offloaded with the device.
This means that providers now have another choice when it comes to wound-care offloading casts. Patients are not limited to a heavy and bulky total contact cast. If you or your physician would like more information, please feel free to email us at info@ActivArmor.ca or call us at 1-873-500-5228. We are more than happy to help answer your questions.