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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Resources and Services Administration

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Foot Care - Intro to Casting (Total Contact Cast)

There are many techniques and devices available to facilitate healing of plantar ulceration.  One of the most effective tools is the Total Contact Cast (TCC).  The TCC differs from the conventional fracture cast in the design and use of padding.  The first cast is applied for approximately 1 week or less if excessive drainage is expected.  Subsequent casts are changed every 2 weeks.  Average healing time is 6 weeks.  Charcot fractures are cast up to 3 months or when surface temperatures are within 2 degrees centigrade.

Indications:

Total Contact Cast (TCC) image.

  • Plantar ulcerations of the insensitive foot
  • Neuropathic fractures (Charcot fractures)
 

Contraindications:

  • Acute infection

  • Tracking wound, ulcer depth greater than width

  • Excessively draining wound

  • Claustrophobia

  • Fragile skin

  • Excessive swelling

 

Advantages: 

  • Immobilization

  • Protect tissue from further trauma

  • Reduce/control edema

  • Maintain ambulation

 

Disadvantages: 

  • Possible joint stiffness if immobilization is prolonged

  • Possible secondary abrasions if cast is improperly applied or not carefully monitored