Abstract
The total contact cast (TCC) is a useful treatment to offload neuropathic foot ulcers. The classical TCC is applied with the patient lying in a supine position, using minimal undercast padding with added protection at the bony prominences followed by a top layer of Plaster of Paris. The TCC has been modified such that it is a semi-rigid boot made of a synthetic casting tape that has cotton wool and semi-compressed felt applied under it, with the foot being cast at a 90° angle to the leg. It is applied from the tip of the toes to the tibial tuberosity. The plantar pressure is evenly distributed through the sole of the foot and also transferred to the lower leg by covering a large surface area of the foot and leg with casting tape. Several randomised controlled trials have shown that the TCC can be more effective than removable devices, both in healing of foot ulcers and also in reducing time to healing. Patients treated with TCCs need education to discuss advantages and disadvantages of this treatment and in particular to be warned of signs that may indicate infection or pressure rubs within the cast. Overall, patients need close surveillance, ideally within a multidisciplinary foot clinic.
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