1. VINAYA. A.S. Clinical Podiatrist & Co - ordinator Foot Clinic Bhagwan Mahaveer Jain Hospital Bangalore Karnataka INDIA

2. TOTAL CONTACT CASTING Effective, rapid & ambulatory therapy for HEALING Diabetic neuropathic plantar ulcer (CAST APPLICATION)

3. TOTAL CONTACT CASTING Benefits –Shortens the period of healing by off loading –Shortens bed - rest in the hospital –Reduces the cost of dressing –Prevents other complications

4. TOTAL CONTACT CASTING In practice from the 1930s Started with Hansen’s disease To treat neuropathic plantar ulcerations

5. TOTAL CONTACT CASTING TCC reduces peak plantar pressures It increases the surface area of the foot for forefoot and mid - foot It allows pedal ulcers to heal rapidly Healing time with TCC is 36 to 43 days approximately

6. TOTAL CONTACT CASTING Indication for TCC GRADE 1 & GRADE 2 plantar ulcerations in the presence of insensitivity

7. TOTAL CONTACT CASTING Contraindication for TCC –Active or acute deep infection –Ulcer depth greater than ulcer width –Excessive leg or foot swelling –Patient unwilling to have cast on extremity

8. TOTAL CONTACT CASTING Contraindication for TCC –Patient unwilling to comply with follow up visits or wearing precautions –Patient unsafe in mobility while in cast –Depends on doppler pressure

9. TOTAL CONTACT CASTING Advantages –Maintains the ambulations –Reduces excessive plantar pressures –Protects foot from further trauma –Immobilisation helps localise & prevent the spread of infection –Controls oedema –Requires minimum patient compliance

10. TOTAL CONTACT CASTING Disadvantages –Impairs mobility (walking,performing basic and instrumental activities of daily living, balance, co - ordination) –Joint Stiffness –Muscle atrophy - if immobilisation is prolonged –Skin abrasions –New ulcerations if cast is poorly applied –poor monitoring (foul odour due to drainage)

11. TOTAL CONTACT CASTING Cast Application –Trace the ulcer –Cover it with thin dressing –Foam covering for bony prominences –Cover the bony prominences with first layer of cast –Cover medial,lateral,posterior and plantar walls of the cast –Wait for 24 hours to allow the inner layers to thoroughly set.

12. TOTAL CONTACT CASTING Instructions to Patients Inform podiatrist in case of : –Any swelling –Cast is tight –Loosening or excessive mobility of the foot in the cast –Drainage on the outside of the cast –Deep cracks or soft spots in the cast –Sudden tenderness on the inguinal lymph nodes

13. TOTAL CONTACT CASTING TCC is the “Gold Standard” among the methods used to heal “Diabetic Foot Ulcers” Supports Numerous clinical reports One controlled clinical trial over the past 25 years

14. TOTAL CONTACT CASTING TCC and other off - loading methods remain the “corner - stone” for healing “pedal ulcers” TCC may be used in conjunction with other methods

15. Thank You For more details mail at: vinaya_as@rediffmail.com