Total contact casting (TCC) is an especially designed cast designed to take bodyweight off of the foot (off-loading) within patients with diabetic feet ulcers (DFUs). Reducing pressure on the wound by taking weight from the foot has shown to be very effective within DFU treatment. DFUs can be a major factor leading to leg amputations among the diabetic inhabitants in the US with 85% involving amputations in diabetics being preceded with a DFU.

Additionally, the 5-year post-amputation fatality rate among diabetics is estimated with around 45% for those struggling with neuropathic DFUs.

Total contact casting continues to be used for off-loading DFUs in America since the mid-1960s and it is regarded by many practitioners as the “reference standard” for off-loading the bottom surface (sole) of the feet.

TCC consists of encasing the patient’s complete feet, including toes, and also the lower leg in a specialist cast that redistributes weight and stress in the lower leg and feet during everyday movements. This particular redistributes pressure from the foot in the leg, which is more able to bear weight, to safeguard the wound, allowing it to regenerate tissue and heal. TCC also keeps the ankle from rotating during strolling, which prevents shearing and twisting forces that can further damage the wound.

Effective away loading is a key treatment technique for DFUs, particularly those that result in damage to the nerves in the feet (peripheral neuropathy). Along with disease management and vascular evaluation, TCC is a vital aspect to effectively controlling DFUs. TCC is considered the most effective and reliable means for off-loading DFUs.

The usage of TCC for feet ulcers caused by leprosy (Hansen's disease) was through Joseph Khan in India within the 1930s. Research conducted by simply Paul W. Brand, MD, in the 1940s and 50s, also in Indian, demonstrated that the wounds within the feet were caused by sensation problems damage (neuropathy) rather than disease, as previously thought. In the use of TCC to eliminate weight and pressure about the ulcers, he observed the healing of ulcers that were present for a long period. These types of seminal observations resulted in the introduction of treatments to manage neuropathic foot ulcers that are useful for patients with a diabetic.

More than 40 years ago, TCC was brought to the United States by Doctor Brand, then at the National Hansen’s Disease Center within Carville, Louisiana. The purpose of TCC was to deliver weight over the entire foot and lower leg. [12] Over time, the staff with Carver Hospital refined the method to lessen the development of other injuries that occur in part due to the initial problem with the feet (secondary ulceration).

Components have changed through the years, from your unmodified plaster of Paris, France, to formulations that contain fiberglass. However, plaster involving Paris casts take too long to completely dry and limits patient flexibility for up to 74 hrs — if the patient walks about the cast during this period, the shape will alter, and the cast will not likely protect the foot and injury correctly. Fiberglass casts were presented in the 1980 or '90s. The curing time of the fiberglass cast is far smaller than plaster of Paris, allowing the patient walk with an external boot within an hour of application. Because casts made from fiberglass have lower breakdown price and do not impede patient flexibility, this material is among the most choice for TCC

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