Total contact casting

Total Contact Casting (TCC) is a specialized casting technique used primarily in the management of diabetic foot ulcers and other non-healing wounds. It involves the application of a non-removable cast that is molded to the exact contours of the patient's foot and lower leg, providing uniform pressure distribution across the surface. This method is considered the gold standard for off-loading diabetic foot ulcers, promoting healing by reducing pressure and friction on the wound site.

Indications

Total Contact Casting is indicated for the treatment of:

• Diabetic foot ulcers
• Charcot foot
• Non-healing wounds due to peripheral neuropathy
• Pre-ulcerative conditions in high-risk patients

Mechanism of Action

The primary mechanism by which TCC promotes healing is through off-loading, or pressure relief, of the ulcerated area. By distributing weight and pressure evenly across the foot and lower leg, TCC reduces the mechanical stress on the wound, allowing for optimal healing conditions. Additionally, the immobilization provided by the cast can reduce edema and protect the area from further injury.

Application

The application of a Total Contact Cast involves several steps:

1. The wound is first cleaned and dressed with appropriate wound care materials.
2. Protective padding is applied to bony prominences and sensitive areas.
3. A layer of stockinette is stretched over the foot and leg.
4. The cast technician then applies plaster or fiberglass casting material, molding it closely to the contours of the foot and leg.
5. Once the cast has hardened, it is checked for proper fit and alignment.

Advantages

• Promotes faster healing of ulcers by off-loading and protecting the wound
• Reduces the risk of amputation in patients with diabetic foot ulcers
• Limits patient mobility to prevent further injury to the foot

Disadvantages

• Requires specialized training to apply correctly
• Non-removable, making skin and wound inspection more difficult
• May be less tolerated by patients due to the bulk and weight of the cast

Conclusion

Total Contact Casting is a highly effective treatment modality for diabetic foot ulcers and other non-healing wounds, offering significant benefits in terms of healing rates and prevention of complications. However, its success depends on proper application and patient compliance.