Total contact casting is an effective and ambulatory therapy for healing diabetic neuropathic plantar ulcers. It offloads pressure and shortens healing time to 36-43 days by immobilizing the foot and redistributing pressure. Total contact casting is indicated for grade 1 and 2 plantar ulcers with insensitivity and contraindicated for active infection, ulcers deeper than wide, or excessive swelling. It maintains ambulation while reducing pressure and protecting the foot during healing.

1. VINAYA. A.S.
Clinical Podiatrist
&
Co - ordinator Foot Clinic
Bhagwan Mahaveer Jain Hospital
Bangalore
Karnataka
INDIA

2. TOTAL CONTACT CASTING
Effective, rapid & ambulatory therapy
for
HEALING
Diabetic neuropathic plantar ulcer
(CAST APPLICATION)

3. TOTAL CONTACT CASTING
• Benefits
– Shortens the period of healing by off
loading
– Shortens bed - rest in the hospital
– Reduces the cost of dressing
– Prevents other complications

4. TOTAL CONTACT CASTING
• In practice from the 1930s
• Started with Hansen’s disease
• To treat neuropathic plantar
ulcerations

5. TOTAL CONTACT CASTING
• TCC reduces peak plantar pressures
• It increases the surface area of the
foot for forefoot and mid - foot
• It allows pedal ulcers to heal rapidly
• Healing time with TCC is 36 to 43
days approximately

6. TOTAL CONTACT CASTING
• Indication for TCC
GRADE 1 & GRADE 2
plantar ulcerations in the presence of
insensitivity

7. TOTAL CONTACT CASTING
• Contraindication for TCC
– Active or acute deep infection
– Ulcer depth greater than ulcer width
– Excessive leg or foot swelling
– Patient unwilling to have cast on
extremity

8. TOTAL CONTACT CASTING
• Contraindication for TCC
– Patient unwilling to comply with follow
up visits or wearing precautions
– Patient unsafe in mobility while in cast
– Depends on doppler pressure

9. TOTAL CONTACT CASTING
• Advantages
– Maintains the ambulations
– Reduces excessive plantar pressures
– Protects foot from further trauma
– Immobilisation helps localise & prevent
the spread of infection
– Controls oedema
– Requires minimum patient compliance

10. TOTAL CONTACT CASTING
• Disadvantages
– Impairs mobility (walking,performing
basic and instrumental activities of daily
living, balance, co - ordination)
– Joint Stiffness
– Muscle atrophy - if immobilisation is
prolonged
– Skin abrasions
– New ulcerations if cast is poorly applied
– poor monitoring (foul odour due to
drainage)

11. TOTAL CONTACT CASTING
• Cast Application
– Trace the ulcer
– Cover it with thin dressing
– Foam covering for bony prominences
– Cover the bony prominences with first
layer of cast
– Cover medial,lateral,posterior and
plantar walls of the cast
– Wait for 24 hours to allow the inner
layers to thoroughly set.

12. TOTAL CONTACT CASTING
Instructions to Patients
• Inform podiatrist in case of :
– Any swelling
– Cast is tight
– Loosening or excessive mobility of the
foot in the cast
– Drainage on the outside of the cast
– Deep cracks or soft spots in the cast
– Sudden tenderness on the inguinal
lymph nodes

13. TOTAL CONTACT CASTING
TCC is the “Gold Standard” among
the methods used to heal
“Diabetic Foot Ulcers”
Supports
• Numerous clinical reports
• One controlled clinical trial over the
past 25 years

14. TOTAL CONTACT CASTING
TCC and other off - loading methods
remain the “corner - stone”
for healing
“pedal ulcers”
TCC may be used in conjunction
with other methods

15. Thank You
For more details mail at:
vinaya_as@rediffmail.com