Total Contact Casts: the gold standard for off-loading plantar diabetic foot ulcers. How can you make it work in a busy clinic?

The total contact cast (TCC) has long been recognized as the gold standard for offloading plantar foot ulcers. However, this treatment modality is timely and costly. This wound care program sees in excess of 900 patients per month in a setting with only six exam rooms.  When dealing with this volume, clinical effectiveness and efficiency are difficult but essential objectives. Weight bearing restrictions are the most fundamental and difficult of patient responsibilities. The TCC relieves these patient responsibilities and promotes plantar foot ulcer healing by fully offloading a foot while bearing weight.  This casting process is complicated by the cost and availability of various materials, patient and clinical staff education needs, application and drying time requirements, as well as regular follow up needs of patients. With the introduction of a TCC kit* this process was simplified and initiated at this clinic.

Following the establishment of a team including podiatrists and wound care nurses, this clinic began applying TCC on a select group of patients. With a TCC kit*, all of the necessary materials are at hand including patient instructions. A process was established and staff educated on a method of casting to expedite patient visits. The cast patients are scheduled on Monday for initial casting and Thursdays for re-application. Subsequent visits take place on a weekly basis.  With this unique process and teamwork, the average number of cast patients has grown to 10-15 per “cast day.” This poster presentation will illustrate the process of TCC application in busy wound care clinic.  After three years of using the TCC kit* and following the procedures put in place using a team of physicians and nurses, TCC for off-loading plantar foot ulcers is now a standard of care at this clinic.