Total Contact Casting: Case Studies of Unique Lower Extremities

Total contact casting (TCC) has been shown to increase healing of patients with diabetic foot ulcers and is considered the gold standard for of-floading and ulcer management. Taking pressure off a wound is key to closure, but TCC is an underutilized modality. Caregivers erroneously believe casting is time consuming, difficult to apply and remove. This poster will describe three patients with unique and challenging anatomy and diagnoses, not limited to diabetes that quickly healed with aid from casting.

A roll-on total contact cast was used to treat R.F., a 68-year-old male with diabetes and no co-morbidities, admitted to the clinic following hospitalization for cellulitis of the foot related to an ulcer. The patient had had no specific wound care or offloading for six months. A cast was placed on the second visit and changed twice weekly. The wound closed in four weeks.

Due to neuropathy and subsequent drop foot, a traditional contact cast was used to treat P.W., an 80-year-old non-diabetic female with a stage 4 pressure ulcer to the lateral aspect of her foot. With seven weeks of advanced wound care and off-loading prior to admission, the wound failed to progress.  Subsequently, a cast was placed weekly to relieve pressure to the area and provide a walking surface. A bioskin equivalent was also placed on the wound, and after 14 weeks the wound closed.

A traditional contact cast was also utilized to treat L.N., a 48-year-old female with uncontrolled diabetes, Charcot joint, recurring bilateral foot ulcers and multiple toe amputations. Her weight and foot structure made offl-oading with standard shoes difficult. Faced again with treating simultaneous wounds, and not wanting to sacrifice one foot to heal the other, she agreed to bilateral casting. With advanced wound care and weekly cast changes both wounds were healed in 7 weeks.