Total Contact Cast
The “total contact cast” is a casting technique that is used to heal diabetic foot ulcers and to protect the foot during the early phases of Charcot fracture dislocations. The cast is used to heal diabetic foot ulcers by distributing weight along the entire plantar aspect (sole) of the foot. It is applied in such a way to intimately contact the exact contour of the foot; hence, the designation “total contact cast.”
By relieving the pressure on the prominent areas of the foot, the ulcers are permitted to heal if the cast is applied in such a way that the patient can remain ambulatory during the treatment of the ulcer. The principle involved here is that the cast is molded to the contours of the foot from the back of the heel through the arch region, in the region of the metatarsals, around them and even to the toes. Pressure is expressed in terms of force or pounds over area per square inch. Therefore, if the weight-bearing area is enlarged the pressure per unit of weight-bearing area diminishes. In this way the pressure which has been concentrated on the bony prominence is distributed over the entire plantar aspect of the foot, allowing reversal of the mechanism that caused the ulcer to occur.