Safety of total contact casting in high-risk patients with neuropathic foot ulcers

Foot Ankle Int. 2004 Aug;25(8):556-60. doi: 10.1177/107110070402500808.


Background: Total contact casting (TCC) is effective in offloading the plantar aspect of the foot in patients with diabetes and neuropathic ulcers. These patients are considered at high risk for skin-related complications during TCC because of sensory neuropathy. The purpose of this prospective study was to determine the frequency of complications during treatment of neuropathic ulcers with TCC.

Methods: Thirteen patients with 18 neuropathic ulcers were treated with TCC. The same orthopaedic surgeon applied a consecutive series of 82 total contact casts. The initial cast was changed in 3 to 4 days, while subsequent casts were changed weekly.

Results: Fourteen complications occurred during the 82 castings (17%). None of the complications required alteration in the treatment protocol. Thirteen of the 14 complications involved skin irritation and the other complication was from a cast that became too tight. Fifteen of the 18 neuropathic ulcers healed with TCC.

Conclusions: TCC can be used safely in high-risk patients with neuropathic problems, but minor complications should be anticipated. Major complications that interfere with the treatment of the plantar ulcer can be minimized with careful technique, close follow-up, and thorough patient education.

MeSH terms

  • Adult
  • Aged
  • Casts, Surgical / adverse effects*
  • Diabetic Foot / therapy*
  • Female
  • Foot Ulcer / therapy
  • Humans
  • Male
  • Middle Aged
  • Pressure Ulcer / etiology*
  • Prospective Studies
  • Risk Factors