A total contact cast is a specialized orthopedic device designed to facilitate the healing of serious foot and ankle conditions. This type of cast extends from the patient’s foot up to just below the knee, maintaining continuous contact with the entire surface of the foot and lower leg. Its primary purpose is to provide a protective and stable environment for healing, particularly for complex wounds or injuries.
What It Is and Why It’s Used
A total contact cast is custom-molded to the unique contours of a patient’s foot and lower leg. This close fit ensures complete contact with the skin, which is essential for its function. It is constructed from materials like fiberglass or plaster, encasing the entire foot, including the toes, and extending up the calf.
This specialized cast is indicated for conditions requiring pressure reduction and immobilization. It is a standard treatment for neuropathic plantar diabetic foot ulcers, which are open sores on the bottom of the foot common in individuals with diabetes. The cast helps offload pressure from these vulnerable areas, allowing ulcers to heal. It also protects the foot during the early, unstable phases of Charcot neuroarthropathy, a condition where bones and joints in the foot weaken and can break due to nerve damage. The cast stabilizes the foot to prevent further damage and support healing.
How It Functions
A total contact cast functions by redistributing pressure across a larger surface area of the foot and lower leg. By closely conforming to the limb, the cast spreads the load that would normally concentrate on a wound or injured site over its entire surface. This reduces localized pressure on the affected area, promoting tissue regeneration and healing.
The cast also provides immobilization of the foot and ankle joints. This prevents movement that could disrupt healing tissues or exacerbate an injury. The firm enclosure controls frictional shearing forces, which are stresses that occur when skin moves against underlying tissues, a common cause of wound aggravation. The cast can also reduce stride length during walking, slowing the foot and lessening impact forces. This mechanical support protects the injured area, allowing natural healing processes to proceed.
Living with a Total Contact Cast
Application of a total contact cast typically involves a healthcare professional molding the material directly to the leg and foot. A thin dressing is applied over any ulcers, followed by a layer of stockinette and minimal protective padding to bony areas. After application, patients are advised to remain non-weight-bearing for a short period to allow the cast to set fully.
Daily care requires keeping the cast dry and inspecting it daily for signs of damage like cracks, soft spots, or foul odors. Patients should avoid getting the cast wet during bathing, often using a waterproof cover. Regular checks of the skin around the cast edges and on the unaffected foot are important to identify any rubbing or irritation. Weight-bearing limitations communicated by the healthcare provider must be followed; excessive walking can be detrimental. Any new or increased pain, swelling, fever, or unpleasant smell from the cast warrants immediate contact with a healthcare provider, as these can be signs of infection or other complications.
When It’s Removed and Next Steps
The duration a total contact cast is worn varies, but it is often worn for several weeks for ulcer healing. A healthcare professional removes the cast using specialized tools to cut and remove it without injuring the skin. This typically involves cutting along the sides of the cast and prying it open.
Immediately after removal, the skin may appear dry, pale, or flaky, and some temporary swelling is common. Skin care involves gentle washing and moisturizing to restore skin health. Continued medical advice is important for preventing recurrence of the initial problem. This includes transitioning to specialized footwear or orthotics designed to continue offloading pressure from vulnerable areas. Regular follow-up appointments monitor the healed site and ensure ongoing protection.