Ontario Begins Funding Total Contact Casting—But Is It Enough?
Three years ago, WoundCareWeekly highlighted a troubling reality in Ontario: while thousands of diabetic patients were undergoing lower-limb amputations annually, the province refused to publicly fund proven offloading treatments like total contact casting (TCC). In that post, we quoted Registered Nurses’ Association of Ontario (RNAO) CEO Doris Grinspun, who memorably criticized the government’s inaction: “We’re willing to pay for the amputations but we’re not willing to pay for the prevention.”
Today, we’re pleased to report that the province has taken a step forward.
Ontario’s Ministry of Health, following recommendations by Health Quality Ontario (HQO), has committed to funding three forms of offloading devices: fibreglass total contact casts, removable cast walkers, and irremovable cast walkers for patients with neuropathic diabetic foot ulcers. A $8 million provincial investment, announced in 2023, will roll out over three years and aims to improve access to these devices through Local Health Integration Networks and Aboriginal Health Access Centres.
The funding covers offloading systems that cost between $150 and $620—minimal compared to the estimated $74,000 per limb spent on amputations. More importantly, this policy aligns with international best practices that emphasize offloading as the single most critical component in healing plantar diabetic foot ulcers.
But as with many bureaucratic victories, implementation lags behind intention. Access to trained professionals capable of applying TCCs, inconsistencies in supply chains, and variability in clinical awareness mean many patients still aren’t receiving the gold standard in care.
We commend Ontario for making this move—but the real test will be in delivery. We’ll continue to follow how this funding translates to outcomes and whether it lives up to the promise of reducing preventable amputations in a system that can no longer afford inaction.
For more background, read our original editorial: “We’ll Pay for the Amputation, But Not the Prevention”
Keywords:
Total Contact Casting,
Diabetic Foot Ulcers,
Ontario Health Policy,
Offloading Devices,
Doris Grinspun,
RNAO,
Amputation Prevention