I'm interested in taking the CWCA exam, but a friend of mine mentioned that the WCC is better. What is the difference between the two?
Offloading Difficult Wounds and Conditions in the Diabetic Patient
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Lower extremity wounds represent significant medical and financial challenges to the healthcare system. This is especially the case in the diabetic population where neuropathy, often associated with vascular disease, can lead to ulceration, immobility, infection, and gangrene. One study places the average cost of healing a single diabetic ulcer at approximately $36,000,1 leading to direct costs of $600 million dollars annually.2 Limitations on mobility caused by foot ulcers have a negative impact on social, psychological, physical, and economic domains.3 Charcot arthropathy can create additional complications; all of these sequelae can lead to major limb amputation.1 Early recognition and prompt management of these foot ulcers can facilitate healing.4 Additional data suggest that meticulous, scientifically based wound care and patient education strategies can reduce lower extremity amputation rates by reducing the frequency and severity of foot ulcers.5
In response to the high costs of managing chronic wounds, systems of comprehensive outpatient care have been established and represent an interdisciplinary and collaborative approach to wound management. The goals of wound care protocols are to treat underlying conditions that cause wounds, facilitate the wound healing process, and minimize skin breakdown and wound recurrence.6 The scope of potential interventions includes debridement, infection control, offloading, protective and active dressings, revascularization, proper nutrition, and patient education.7 Offloading is important for reducing foot pressure points8 and for prevention,9 as well as for healing.10
The following article discusses offloading difficult wounds and Charcot foot at various stages of treatment and prevention. The pedorthic management of foot amputations also will be discussed.
The Neuropathic Ulcer
The main cause of foot ulceration is neuropathy (see Figure 1).11 This leads to prolonged and excessive pressures that cause tissue breakdown. Using footwear as a means of healing open wounds is rarely desirable.12 Currently, total contact casting (TCC) (see Figure 2) represents the gold standard for the treatment of forefoot and midfoot (Wagner grade 1-2) diabetic and neuropathic ulcerations; however, reduction of heel pressures with this device remains controversial. Myerson et al13 estimate that 6 weeks of treatment in a total contact cast costs the same as a single day of inpatient treatment. Specialized casting protects the foot from trauma, immobilizing skin edges and reducing edema. It decreases pressure over the ulcer by redistributing the weightbearing load over a greater plantar surface area.
Molding the bottom of the cast to the bottom of the foot causes the entire sole to participate in the force distribution, resulting in lower pressures.14 In 1985, Birke et al15 reported 75% to 84% reduction of peak pressure at the first and third metatarsal heads, respectively, when subjects walked in a cast. Many other studies have supported the successful rationale for TCC use. For example, Sinacore et al16 noted healing in 82% of 33 ulcers after an average of 44 days in a total contact cast. Myerson et al13 observed healing in 64 out of 71 (90%) ulcers at a mean of 5.5 weeks. Hanft et al17 performed a 10-year retrospective study utilizing total contact casts on more than 1,000 patients. The research demonstrated a healing rate of 91% within 13 weeks with an average closure time of 4.36 weeks (± 1.31 weeks). It was concluded that the total contact cast was an effective, low-risk, and inexpensive treatment for plantar diabetic foot ulcers.
References:
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