The adjunct use of a Böhler Walker together with a Total Contact Cast has the potential to broaden the scope of use of Total Contact Casting

Ben So, Michael Edmonds, Maureen Bates, Erika Vainieri, Chris Manu

Mike Edmonds Foot Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom

Background & Aims

Offloading with a below knee total contact cast (TCC) remains the gold standard for diabetic foot ulcer (DFU) and Charcot foot. However, its uptake is sometimes restricted or suboptimal. We had noted an increased use of Böhler Walker together with TCC.

The aim of the study was to review the various indications for the use of Böhler walker with TCC within our service.

Methods

A retrospective cohort review of patients who were offloaded with a combination of a Böhler walker and TCC between October 2023 and March 2026.

Clinical notes were reviewed with analyses of patients’ demographics and categorised the indications for use and its effectiveness and tolerance by the patients.

Results

The demographic characteristics (Table 1) and cohorts of patients offloaded with TCC plus Böhler Walker (Figure 5) are presented below.

No adverse events were reported by the patients. The TCC plus Böhler walker was tolerated well even by the elderly and facilitated early discharge from hospital.

Conclusion

The use of Böhler Walker can be safely considered together with a TCC as an offloading option for complex DFUs not responding to standard TCC.

It can be used for patients with poor balance, or those who cannot safely manage full non-weight bearing after foot and ankle surgery.