{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:14Z","timestamp":1783509254610,"version":"3.55.0"},"reference-count":14,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11]]},"abstract":"\n Background:<\/jats:title>\n Although total-contact cast (TCC) systems are considered the gold standard for off-loading plantar ulcers, less than 6% of patients with diabetic foot ulcers receive them due to negative perceptions of special technique requirements and time investment in their application and removal. We compared the ease of use and casting time of four TCC systems.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Four novice casters applied each of the four TCC systems three times using the manufacturer's written instructions for cast application and removal of each cast type. For each TCC system, casters also provided ratings of quality and effectiveness, their level of confidence in applying each system, and overall ease of use.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n The time to complete the first application of each cast type was not different among TCC systems. However, by the third application, TCC-EZ had a significantly faster application time than the other three TCC systems. In addition, TCC-EZ was considered better overall in packaging and instructions, quality of cast components, and casting method than the other TCC systems. Half of the casters rated TCC-EZ and MedE-Kast as the easiest to apply after the third and final trial, and TCC-EZ and MedE-Kast were rated as being the cast chosen to use in the casters' clinical practices.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n One of the obstacles to use of TCC systems, despite being recognized as the gold standard of off-loading, is the perception of a prolonged learning curve on application. This study demonstrated that TCC-EZ can be applied by novice casters in less than 14 minutes after their third application experience.<\/jats:p>\n <\/jats:sec>","DOI":"10.7547\/17-222","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T10:55:12Z","timestamp":1574420112000},"page":"445-450","source":"Crossref","is-referenced-by-count":4,"title":["Ease of Application and Removal of Common Total-Contact Cast Systems Used in the Podiatric Medical Community"],"prefix":"10.3390","volume":"109","author":[{"given":"Kathy","family":"Ludwig","sequence":"first","affiliation":[{"name":"College of Nursing and Health Sciences, Barry University, Miami Shores, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Von","family":"Homer","sequence":"additional","affiliation":[{"name":"College of Nursing and Health Sciences, Barry University, Miami Shores, FL."},{"name":"School of Podiatric Medicine, Barry University, Miami Shores, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Jensen","sequence":"additional","affiliation":[{"name":"School of Podiatric Medicine, Barry University, Miami Shores, FL."},{"name":"Arizona School of Podiatric Medicine, Midwestern University, Glendale, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-109-6-445-b01","series-title":"National diabetes statistics report","article-title":"estimates of diabetes and its burden in the United States","year":"2014","unstructured":"National diabetes statistics report, 2014: estimates of diabetes and its burden in the United States. Available at: https:\/\/www.cdc.gov\/diabetes\/pdfs\/data\/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf."},{"key":"i8750-7315-109-6-445-b02","series-title":"JAPMA","first-page":"360","article-title":"Off-loading the diabetic foot for ulcer prevention and healing","volume":"100","author":"Cavanagh \n PR,","year":"2010","unstructured":"Cavanagh \n PR, \n \n \n Bus \n SA: \n \n \n Off-loading the diabetic foot for ulcer prevention and healing. JAPMA100: 360, 2010."},{"key":"i8750-7315-109-6-445-b03","series-title":"The Diabetic Foot,","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/978-1-61779-791-0_11","article-title":"\u201cBiomechanics of the Diabetic Foot: The Road to Foot Ulceration,\u201d","author":"van Schie \n C,","year":"2012","unstructured":"van Schie \n C, \n \n \n Slim \n FJ\n \n : \u201cBiomechanics of the Diabetic Foot: The Road to Foot Ulceration,\u201dinThe Diabetic Foot,ed byAVeves, JMGiurini, FWLoGerfo, p203, Humana Press, New York, 2012.10.1007\/978-1-61779-791-0_11"},{"issue":"suppl 1","key":"i8750-7315-109-6-445-b04","series-title":"Diabetes Metab Res Rev","doi-asserted-by":"publisher","first-page":"S162","DOI":"10.1002\/dmrr.850","article-title":"The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review","volume":"24","author":"Bus \n SA,","year":"2008","unstructured":"Bus \n SA, \n \n \n Valk \n GD, \n \n \n van Deursen \n RW\n \n et al: \n The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev24(suppl 1): S162, 2008.http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000256408300027&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1002\/dmrr.85018442178"},{"issue":"suppl 1","key":"i8750-7315-109-6-445-b05","series-title":"Diabetes Metab Res Rev","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1002\/dmrr.2702","article-title":"Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review","volume":"32","author":"Bus \n SA,","year":"2016","unstructured":"Bus \n SA, \n \n \n van Deursen \n RW, \n \n \n Armstrong \n DG, \n \n et al: \n Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev32(suppl 1): 99, 2016.http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000369134100010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1002\/dmrr.270226342178"},{"key":"i8750-7315-109-6-445-b06","series-title":"Diabetes","first-page":"1019","article-title":"Offloading the diabetic foot wound","volume":"24","author":"Armstrong \n DG,","year":"2001","unstructured":"Armstrong \n DG, \n \n \n Nguyen \n HC, \n \n \n Lavery \n LA, \n \n et al: \n Offloading the diabetic foot wound. Diabetes24: 1019, 2001."},{"key":"i8750-7315-109-6-445-b07","series-title":"Int Wound J","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1111\/iwj.12213","article-title":"Randomised clinical trial to compare total contact casts, healing sandals and a shear-reducing removable boot to heal diabetic foot ulcers","volume":"12","author":"Lavery \n LA,","year":"2015","unstructured":"Lavery \n LA, \n \n \n Higgins \n KR, \n \n \n La Fontain \n J, \n \n et al: \n Randomised clinical trial to compare total contact casts, healing sandals and a shear-reducing removable boot to heal diabetic foot ulcers. Int Wound J12: 710, 2015.http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000364708200017&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111\/iwj.12213"},{"key":"i8750-7315-109-6-445-b08","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"384","DOI":"10.2337\/diacare.12.6.384","article-title":"Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial","volume":"12","author":"Mueller \n MJ,","year":"1989","unstructured":"Mueller \n MJ, \n \n \n Diamond \n JE, \n \n \n Sinacore \n DR, \n \n et al: \n Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care12: 384, 1989.10.2337\/diacare.12.6.3842659299"},{"key":"i8750-7315-109-6-445-b09","series-title":"Arch Phys Med Rehabil","first-page":"217","article-title":"Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location","volume":"68","author":"Walker \n SC,","year":"1987","unstructured":"Walker \n SC, \n \n \n Helm \n PA, \n \n \n Pulliam \n G: \n \n \n Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil68: 217, 1987.3566513"},{"key":"i8750-7315-109-6-445-b10","series-title":"Wound Repair Regen","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1111\/j.1524-475X.2010.00571.x","article-title":"Why is it so hard to do the right thing in wound care?","volume":"18","author":"Fife \n CE,","year":"2010","unstructured":"Fife \n CE, \n \n \n Carter \n MJ, \n \n \n Walker \n D: \n \n \n Why is it so hard to do the right thing in wound care?\n Wound Repair Regen\n 18: 154, 2010.10.1111\/j.1524-475X.2010.00571.xhttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000275760600004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-109-6-445-b11","series-title":"Adv Skin Wound Car","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1097\/01.ASW.0000450831.65667.89","article-title":"Diabetic foot ulcer offloading: the gap between evidence and practice: data from the US Wound Registry","volume":"27","author":"Fife \n CE,","year":"2014","unstructured":"Fife \n CE, \n \n \n Carter \n MJ, \n \n \n Walker \n D, \n \n et al: \n Diabetic foot ulcer offloading: the gap between evidence and practice: data from the US Wound Registry. Adv Skin Wound Car27: 310, 2014.10.1097\/01.ASW.0000450831.65667.89"},{"key":"i8750-7315-109-6-445-b12","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.2337\/dc08-0771","article-title":"Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?","volume":"31","author":"Wu \n SC,","year":"2008","unstructured":"Wu \n SC, \n \n \n Jensen \n JL, \n \n \n Weber \n AK, \n \n et al: \n Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?\n Diabetes Care\n 31: 2118, 2008.http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000260565000010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.2337\/dc08-077118694976"},{"key":"i8750-7315-109-6-445-b13","series-title":"Poster presented at: Clinical Symposium on Advances in Skin and Wound Care, San Antonio, TX","article-title":"Cost effectiveness and implementation of an easy to apply total contact casting system for diabetic grade 2 neuropathic foot ulcers in a multi physician clinic","author":"Bohn \n G:","year":"2009","unstructured":"Bohn \n G: \n \n \n Cost effectiveness and implementation of an easy to apply total contact casting system for diabetic grade 2 neuropathic foot ulcers in a multi physician clinic. Poster presented at: Clinical Symposium on Advances in Skin and Wound Care, San Antonio, TX, October2009."},{"key":"i8750-7315-109-6-445-b14","series-title":"Poster presented at: 18th Diabetic Foot Global Conference, Houston, TX, October 11\u201313","article-title":"TCC-EZ: total contact casting system overcoming the barriers to utilizing a proven gold standard treatment","author":"Jensen \n J,","year":"2008","unstructured":"Jensen \n J, \n \n \n Jaakola \n E, \n \n \n Gillin \n B, \n \n et al: \n TCC-EZ: total contact casting system overcoming the barriers to utilizing a proven gold standard treatment. Poster presented at: 18th Diabetic Foot Global Conference, Houston, TX, October 11\u201313, 2008."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/109\/6\/17-222.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/109\/6\/445\/2458408\/17-222.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/109\/6\/17-222.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/109\/6\/17-222.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:17:48Z","timestamp":1783505868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/109\/6\/445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":14,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.7547\/17-222","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}