Total Contact Cast

Total Contact Cast 1Total Contact Cast




TCC’s heal ulcers by reducing pressure

- 1/3 of load is taken by wall of cast & transmitted to the leg

- 45% reduction in forefoot pressure but not heel pressure


Works best if closely applied & moulded to leg




Protection from trauma


Reduce oedema

Reduce pressure over ulcers

Redistributes pressure over a greater weight bearing surface




1.  Superficial forefoot and midfoot plantar ulceration


Neuropathic Midfoot Ulcers


Deeper ulcers with exposed tendon & bone

- require surgical debridement to convert them to superficial ulcers prior to TCC


2.  Eichenholtz stage I or II neuroarthropathic fractures


3.  Post operative neuropathic foot surgery

- post-op immobilisation after ORIF of acute fractures

- after reconstruction of deformity




1.  Heel ulcers

- not effective

- heel ulcers typically have ischaemic component & osteomyelitis

- TCCs don’t reduce heel pressure


2.  Deep infection

- abscess, osteomyelitis, gangrene

- beware of ulcer with drainage


Treat infection with rest in bed / NWB / Antibiotics


If ulcer is deeper than wide

- surgically debride to open ulcer

- allow deeper layers to heal & convert to superficial ulcer


3.  Poor skin quality

- especially if on steroids or have stasis ulcers


4.  Severe arterial insufficiency (pre-gangrenous feet)

- ABI < 0.45

- Doppler toe pressure < 30mmHg

- TcPO2 < 30


5.  Poor patient compliance

- must attend follow up & follow cast precautians


TCC Application




TCC Toe PaddingTCC Padding Bony Prominences



- absorbent gauze on ulcer

- enclose the toes with gauze between toes to reduce moisture

- seamless stocking

- felt over bony prominences

- avoid overpadding the cast / increases shear forces

- well moulded POP / fibre glass


Post Application Protocol


First 6 weeks

- change weekly

- because oedema subsides quickly

- photos of ulcer at each change


Then 2 weekly

- until ulcer healed / Stage 2 Charcot


6 months / orthosis

- CROW (Charcot restraint orthotic walker)