PRACTICAL GUIDE

The Total Contact Cast (TCC) can be used for the bloodless treatment of neuropathic plantar ulcers and has good results in their closure. It is an easy-to-perform, low-cost, low-morbidity method that allows walking with full weight bearing without walking aids. This guide helps orthopedic professionals understand the disease and make the TOTAL CONTACT CAST with quality and efficiency, reducing the risk of amputations and infections.

DIABETIC FOOT / CHARCOT

ARTHROPATHY / PLANTAR

INJURY / TOTAL CONTACT CAST

First, I thank God for allowing me the opportunity to do this work, it was a lot of work to research everything there is in the world on the subject with the intention of enabling professionals who care for orthopedic patients with problems caused by diabetes.

To my children and grandchildren who are the reason for my existence and it's for them that I wake up every morning

I thank the friends who readily volunteered to help with the translations of the work:

Mr. Charles Barocas CEO of

the American

Society of Orthopedic Professionals - USA

Allen Garita Orthopedic Technologist San Jose - Costa Rica

Massimo Menchella Nurse, Santi cosma and damiano - Italy dream on dream until your dream come true (Aerosmith)

A thousand will fall at your side, and ten thousand at your right hand, but it will not come to you

Psalm 91:7

Francisco Sérgio de Oliveira graduated in nursing in 1993, graduated as a orthopedic technician in 1994 from the Brazilian Society of Orthopedics and Traumatology and a orthopedic technologist from the American Society of Professionals in Orthopedics in 2016.

Specialist in Trauma Nursing by the Brazilian Nursing Association, specialist in cardiac surgery perfusion by the Santa Lucinda hospital, specialist in endoscopic procedures by Olympus and by Santa Casa de São Paulo Master Caster by the American Society of Orthopedic Professionals - ASOP He has worked for 28 years at Sorocaba Hospital Center as an orthopedic technician in an orthopedic clinic.

Charcot's Neuroarthropathy (CNA)

Charcot neuroarthropathy (CNA) is a bone and joint deformity of the neuropathic foot, in which the architecture and structural organization of the bones are altered, with radiographic alterations characterized by bone destruction and remodeling, joint destruction, subluxation and dislocation

Despite recognizing that Mitchell was the first physician to describe osteoarticular destruction associated with neurological dysfunction, it was Charcot who, in 1868, made the first detailed histopathological description of the alterations present in Tabes Dorsalis. In 1881, Paget, at an international medical congress in London, suggested the definition of Charcot's disease for this pathological entity that has several definitions

Although Diabetes is currently the main cause of CNA worldwide, it was only in 1936 that this pathology was described for the first time as a complication of Diabetes Although recognized for over 300 years, CNA remains a complex and difficult entity when it comes to diagnosis and treatment Therefore, healthcare professionals should be aware of this pathology given the growing trend of Diabetes and its complications

Diabetic neuropathy is a nervous disorder caused by diabetes People with the disease can, over time, experience nerve damage throughout the body Some people may not have any symptoms, others may experience pain, tingling or loss of sensation especially in the hands, arms, feet and legs However, these problems can also occur in the digestive system, heart and reproductive organs.

Types

There are four main types of diabetic neuropathy You may have only one type or symptoms of several types Most develop gradually and may go unnoticed until considerable damage occurs:

Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy As the name implies, it affects the extremities of the body, such as feet, legs, hands and arms.

Autonomic neuropathy

The autonomic nervous system controls the heart, bladder, lungs, stomach, intestines, sex organs and eyes Diabetes can affect the nerves in any of these areas, giving rise to autonomic diabetic neuropathy

Diabetic amyotrophy

Rather than affecting nerve endings like peripheral neuropathy, diabetic amyotrophy affects nerves in the thighs, hips, buttocks and legs Also called femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults

Mononeuropathy

Mononeuropathy involves damage to a specific nerve The nerve can be in the face, trunk or leg Also called focal neuropathy, diabetic mononeuropathy often happens suddenly It is more common in older adults Although it can cause severe pain, the disease usually doesn't bring any long-term complications Sometimes mononeuropathy occurs when a nerve is pinched Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes

Causes

Diabetes is a disease that affects blood vessels, both large and small. Our nerves, which can be understood as small electrical wires that transmit information about heat, pain, cold or pressure to our brain, need to receive blood with oxygen to function properly In the case of diabetes, there is a decrease in oxygen reaching the nerves through small blood vessels, and an inflammatory process also forms, both leading to malfunction of the nerves and causing diabetic neuropathy

The exact causes of this damage differ depending on the type of diabetic neuropathy

The damage to the nerves is likely due to a combination of factors:

Metabolic factors such as high blood glucose, long-term diabetes, abnormal blood fat levels, and possibly low insulin levels

Neurovascular factors leading to damage to blood vessels that deliver oxygen and nutrients to nerves

Autoimmune Factors That Cause Nerve Inflammation

Mechanical damage to nerves such as carpal tunnel syndrome

Inherited traits that increase susceptibility to nerve disease

Lifestyle factors such as smoking or alcohol use

Risk Factors

Uncontrolled blood sugar levels: This is the biggest risk factor for all complications from diabetes, including diabetic neuropathy Keeping blood sugar levels under control is the best way to prevent complications

Long-term diabetes: The risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar is not well controlled Diabetic neuropathy is more common in people who have had diabetes for at least 25 years.

Kidney disease: Diabetes can damage the kidneys, which can build up toxins in the blood and contribute to nerve damage

Smoking: Smoking narrows and hardens the arteries, reducing blood flow to the legs and feet This can damage the integrity of peripheral nerves

Diabetic Neuropathy Symptoms

The signs and symptoms of diabetic neuropathy vary depending on the type of neuropathy and nerves that are affected

Peripheral neuropathy

Numbness

Reduced ability to feel pain or changes in temperature, especially in the feet and fingers

Tingling or burning sensation

Pain when walking

Extreme sensitivity to the lightest touch - for some people, even the weight of a sheet can be distressing

Muscle weakness and difficulty walking

Serious foot problems such as ulcers, infections, deformities and bone and joint pain This condition is called diabetic foot

Autonomic neuropathy

No symptoms of hypoglycaemia when blood sugar levels are low

Bladder problems, including frequent urinary infections or urinary incontinence

Constipation, uncontrolled diarrhea or a combination of the two

Slow emptying of the stomach (gastroparesis), leading to nausea, vomiting and loss of appetite

Difficulty in swallowing

Erectile dysfunction

Vaginal dryness

Increase or decrease in sweating

Inability of the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure when standing up, for example

Problems with regulating body temperature

Changes in the way the eyes adjust to a light or dark environment

Increased heart rate at rest

Diabetic amyotrophy

Symptoms usually occur on one side of the body In some cases, symptoms can spread to the other side as well Most people improve at least partially over time However, the symptoms may get worse before they get better This condition is often marked by:

Sudden severe pain in hip, thigh or buttock

Thigh muscles that may be weak or atrophied difficulty getting up

Abdominal bloating if the abdomen is affected

Weight loss

Mononeuropathy

Symptoms usually subside and go away on their own over a few weeks or months

Signs and symptoms depend on which nerve is involved and may include:

Difficulty focusing vision, double vision or pain behind one eye

Paralysis of one side of the face (Bell's palsy) leg or foot pain

Pain in the front of the thigh chest or abdominal pain

Sometimes mononeuropathy occurs when a nerve is pinched Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes

Signs and symptoms of carpal tunnel syndrome include:

Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger

A feeling of weakness in your hand and a tendency to drop things