I recently had the opportunity to speak at a dinner meeting to a group of wound care clinicians. During a question and answer session, the topic of discussion drifted toward the use of total contact casting (TCC). I asked the meeting participants to indicate, with a show a hands, how many of them were using this modality regularly in their practice. I was shocked to see that the number was less than 10 percent.
Numerous authors have described the underlying pathology in the development of lower extremity ulcerations. Perhaps one of the greatest difficulties in managing complex lower extremity ulcerations is offloading the wound site effectively. A review of the literature demonstrates that TCC is the “gold standard” for offloading non-infected, non-ischemic plantar foot ulcerations.1,2
There are several mechanisms that combine to provide the reduction of peak plantar pressures via the use of TCC. Studies have established that the use of TCC decreases altered gait mechanics with shortened stride length and an overall reduction of walking velocity, both of which contribute to the reduction of plantar pressures.3 Furthermore, given the “cone effect” provided by the physical structure of the patient’s leg (an inverted cone), the TCC (a conical receptacle) also allows more even distribution of the patient’s weight read more