Volume 5 Supplement 1

3rd Congress of the International Foot and Ankle Biomechanics Community

Oral presentation
Open Access

Mapping load transfer from the plantar surface of the foot to the walls of the total contact cast (TCC)

  • Lindy Begg1Email author,
  • Patrick McLaughlin2, 3,
  • Leon Manning1,
  • Axel Kalpen4,
  • Mauro Vicaretti1,
  • John Fletcher1 and
  • Joshua Burns1, 5
Journal of Foot and Ankle Research20125(Suppl 1):O12

https://doi.org/10.1186/1757-1146-5-S1-O12

©  Begg et al; licensee BioMed Central Ltd. 2012

Published: 10 April 2012

Background

The mechanism of offloading plantar pressure with a TCC is by redistributing weight-bearing load across the entire plantar surface of the foot and increasing the plantar surface contact area [1]. An additional mechanism is by transfer of load to the cast walls however these studies relied on indirect methods [2–4]. No previous research has directly measured the load on the cast wall.

The aim of this pilot study was to:
  1. 1.

    Systematically map pressure between the walls of the TCC and the lower limb to identify those areas of greatest pressure.

     
  2. 2.

    To directly measure load transfer from the plantar surface of the foot to the cast walls.

     

Materials and methods

A TCC was applied to a 20 year old healthy female and a 32 year old female with a 17 year history of Diabetes Mellitus without complications. The TCC was bi-valved and a capacitance sensor insole (pedar®, novel Gmbh, Germany) was placed on to the plantar area of the TCC and another into the participant’s sport shoe. Pliance® sensors were also placed along the lower leg (pliance®, novel Gmbh, Germany). Both sensors collected data simultaneously. After completion of all seven trials measuring each location of the cast wall, the cast wall of the TCC was cut down to create a shoe-cast.

Results

The two highest pressure locations from the cast-wall pliance® sensors were: posterior to the lateral malleolus and the extensor retinaculum. The average force per step for the resultant cast wall load was 159.2N for the participant with diabetes and 104.8N for the participant without diabetes. With the use of direct measurement it was established that there was a load transfer of 34% from the plantar surface of the foot to the cast walls of a TCC worn by a participant with Diabetes and for the healthy participant 23%.

Conclusions

The results supported the estimated values of 30-35% of load transfer by previous researchers who calculated cast wall data from indirect (plantar) measures.

Declarations

Acknowledgement

This study was funded by the Australian Podiatry Education and Research Foundation.

Authors’ Affiliations

(1)
Foot Wound Clinic, Department of Surgery, Westmead Hospital
(2)
School of Biomedical and Health Sciences, Faculty of Health, Engineering and Science, Victoria University
(3)
Institute of Sport, Exercise and Active Living, Victoria University
(4)
Novel Biomechanics Lab
(5)
Institute for Neuroscience and Muscle Research, The Children’s Hospital at Westmead/Paediatric Gait Analysis Service of New South Wales/Faculty of Health Sciences, The University of Sydney

References

  1. Hartsell HD, Fellner C, Frantz R, Saltzman CL: Prosthetics and orthotics science: the repeatability of total contact cast applications: implications for clinical trials. J Prosthet Orthot. 2001, 13: 4-9. 10.1097/00008526-200103000-00009.View ArticleGoogle Scholar
  2. Leibner ED, Brodsky JW, Pollo FE, Baum BS, Edmonds BW: Unloading mechanism in the total contact cast. FootAnkle Int. 2006, 27: 281-285.Google Scholar
  3. Shaw JE, Hsi WL, Ulbrecht JS, Norkitis A, Becker MB, Cavanagh PR: The mechanism of plantar unloading in total contact casts: implications for design and clinical use. Foot Ankle Int. 1997, 18: 809-817.View ArticlePubMedGoogle Scholar
  4. Tanaka H, Nagata K, Goto T, Hoshiko H, Inoue A: The effect of the patella tendon-bearing cast on loading. J bone joint surg. 2000, 82-B: 228-232.View ArticleGoogle Scholar

Copyright

© Begg et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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