Total Contact Casting was first introduced by Milroy Paul in Srilanka for the treatment of Non-healing ulcers
Indications for Total Contact Casting
- Chronic Non-healing Ulcer associated with neuropathic disorders
- Diabetes mellitus
- Leprosy
- Spinal Injuries
- Reduction of foot/ lower leg edema
- Consolidation of Charcot’s foot
- Postoperative Adjunct to Reconstructive Surgery
Contraindications/ Complications of Total Contact Casting
- Active infection (the dark, moist, and warm atmosphere is an excellent environment for bacterial growth)
- Poor pedal hygiene including elongated nails
- Ischemia (Circumferential bandages should be avoided)
- Noncompliance
- Claustrophobia
Prior to cast application: Ulcer should be evaluated for width and depth
“Ulcer that is deeper than they are width creates a problem since epithelization may occur before the depth of the wound is adequately healed, possibly allowing abscess to form.”
Ulcers are unpacked, treated with open packing then a cast is applied
Extrinsic complication factors include improper removal of the cast
Overaggressive use of saw and scissors can create abrasion and possible new sources of infection and ulcers
Indentation of a cast when a patient ambulates prematurely can create a depression in the cast that can become a new pressure sore.
So, wait for 30 min (Synthetic)/ 24 hr(POP) before full weight bearing on the cast
Biomechanics of TCC
Total Contact Casting helps in
- Diminished pressure on the wound
- Increase surface area on the plantar surface of the foot
- Limits all muscle-tendon activities
Ulcers in the plantar surface of the foot are due to abnormal stress, usually from bony prominences
TCC will Shorten stride length, which reduced gait, and velocity and reduces verticle loading force on the foot
Giving time for ulcers to heal
Application of casting material to the entire skin surface of the foot and leg creates significant contact surface area which can reduce edema significantly
See also: External fixator principles
See also: Functional cast bracing
