total contact casting

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