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Effective Offloading

Protecting the foot with effective offloading

To help ensure these often recalcitrant wounds have the best chance to heal more quickly and completely, it is critical to implement effective offloading that reduces mechanical stress and areas of high pressure.

Video on the Soft TCC Offloading Technique

Video on importance of off-loading

Offloading using the soft TCC

Dr. Bell

The TCC is considered the gold standard, because it protects the foot from trauma, immobilizes skin edges, reduces edema, and decreases pressure by redistributing the weight-bearing load over a greater surface area;2 however, it may not be an option for a variety of reasons, including cost, tolerability, expertise, and time to apply. For these reasons, Desmond Bell, DPM, has developed the soft TCC technique to provide his patients with critical offloading in situations where rigid TCC may not be an option. He recommends this approach to offloading as an alternative because it provides the benefits of nonremovable yet comfortable TCC.

Bell highlights the following benefits he has observed with his use of the soft TCC:

  • Quick application: takes approximately 5 minutes to apply
  • Well tolerated: patients adapt well because the soft TCC is relatively comfortable and less cumbersome than a traditional rigid TCC or other removable walkers and orthoses
  • Reduces edema: the soft TCC offers the added benefit of mild compression, which may assist in edema control or reduction
  • Real-world solution to effective offloading: provides pressure reduction with minimal impact on mobility or gait stability
  • Inexpensive: does not require special dressings or other materials
  • Easy to apply: no special equipment or skills are necessary

See below for illustrated step-by-step instructions on how to apply the soft TCC.

Applying the soft TCC

Recommended follow-up

  • Wound assessment is critical for successful treatment
  • Reapply the soft TCC one to two times weekly until healing is achieved
  • Wound assessment is critical for successful treatment
  • Reapply the soft TCC one to two times weekly until healing is achieved

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  1. Kirsner RS, Herman WH, Funnell MM, et al. The standard of care for evaluation and treatment of diabetic foot ulcers. Barry University website. www.barry.edu/includes/docs/continuing-medical-education/diabetic.pdf. Published July 30, 2010. Accessed February 1, 2013.
  2. Snyder RJ, Lanier KK. Diabetes: Offloading difficult wounds. Lower Extremity Review. 2009. http://lowerextremityreview.com/article/diabetes-offloading-difficult-wounds. Accessed March 8, 2013.
  3. McGuire J. Traditional offloading: an evidence-based approach to pressure redistribution in the diabetic foot. Adv Skin Wound Care. 2010;23(4):175-188.
  4. Armstrong DG, Lavery LA, Kimbriel HR, et al. Activity patterns of patients with diabetic foot ulceration. Diabetes Care. 2003;26(9):2595-2597.
  5. Bell DP, Jr. The "soft total contact cast": a novel method for functional off-loading. Poster presented at: Wound Care on Wheels, Ponte Vedra, FL.
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