The Impact of utilizing Total Contact Casting on Chronic Wounds of the Foot: Less than 60 Days to Total Healing

The aging population and prevalence of multiple comorbidities complicate the care of patients with chronic wounds of varying etiologies including diabetic foot ulcers, pressure ulcers, and wounds related to trauma.  Chronic wounds of the foot frequently fail to move through the repairative process in an orderly, timely fashion. Additionally it is known that diabetic foot ulcers affect 2.5 to 10.7% of all Diabetics which frequently result in amputations. Offloading to redistribute pressure is a basic principle in healing chronic wounds of the foot including diabetic and neuropathic foot wounds. There are multiple methods for offloading however, The Total Contact Cast (TCC) is considered the gold standard for offloading foot wounds.  This series of 6 patient cases with a total of 7 wounds provides significant evidence to further validate why TCC is and should continue to be gold standard for offloading.

     The patients had multiple comorbidities and wounds varying in time of existence from 1 month to 8 months.  Each patient’s wound was treated with dressings including skin substitutes, silver alginates, foams, silver dressings, and activated collagen.  All patients were offloaded utilizing a new quick and easy form of TCC. By utilizing the easier method of TCC it allows the facility to apply TCC within a fifteen minute time frame or less.  In evaluating the outcomes it is evident that using TCC has a direct effect on wound healing to include a significant reflection on total days to heal. These 6 patients had an average of 31.5 days to wound healing ranging from as few as 14 days to 57 days this is significant especially with the variety of comorbidities, wound age, and over half of the patients were diabetic.  Further research is suggested with a larger variance of wound etiologies, more focused wound dressing applications, and evaluating healing times to substantiate observations.