Everything you need to know about Total Contact Casting

What it is:

Total contact casting (or TCC) is a casting technique used to treat diabetic foot ulcers and Charcot foot. In TCC, the entire cast is in total contact with the affected leg. (Pro tip: Use lightweight, fiberglass casting tape rather than the heavier plaster alternative. With such a large area to cover, every ounce counts!). To be effective, the cast must follow the exact contours of the foot, so you’ll want to use the most pliable casting tape you can find. CNF Medical’s Performance Casting® Plus fiberglass cast tape offers a multi-directional, three-plane stretch instead of the typical two-plane stretch, making it the ideal choice for TCC.

Why it works:

The cast distributes weight evenly across the sole of the foot, offloading pressure from the ulcer and bony prominence. With that pressure relieved, the process that created the ulcer will begin to reverse and the foot will heal. The cast also limits movement and protects the infected area from further trauma.

What you need:

• Foam Padding
• Reinforcing Strips
• Cast Padding
• Stockinette
• Cast Tape with superior conformability
• A great assistant

How it’s done:

The TCC process is different from that of a normal cast. When you apply the casting tape, you must ensure the cast is in contact with the entire foot and the leg gets enough blood flow. TCC is a very delicate procedure as the slightest movement or loss of position can create new pressure points (and cause a new ulcer!). You’ll need an attentive assistant to monitor things closely and maintain the position as you apply the casting tape.

The patient should lie in the prone position on his or her stomach, with the affected leg pointed into the air (bent at the knee at a 90-degree angle) with the ankle bent naturally. Apply a thin dressing to the ulcer, followed by a smaller-than-usual stockinette from the toes to just below the knee. (Pro tip: For a higher quality stockinette, opt for one manufactured with the “rib” knit process, like CNF Medical’s Performance Stockinette™. It will maintain its shape when stretched and cut, unlike the cheaper “jersey” knit stockinette.)

Next, apply cast padding between the toes and up the leg and foam padding over the toes and at the bony prominences. Finally, apply the fiberglass casting tape from the toes to just below the knee, ensuring the cast is closely molded to the contours of the sole of the foot.

Summary:

You have now created a Total Contact Cast. The healing process can take 6-8 weeks, during which time, the cast must be replaced every one or two weeks. So, you’ll have plenty of opportunities to perfect your Total Contact Casting technique.