What is a total contact cast

A total contact cast (TCC) is an enclosed non-removable cast. It is used to redistribute pressure on the foot and can be used to treat diabetic foot ulcers, foot fractures, post-surgery wounds and Charcot neuroarthropathy (CN) – an inflammatory syndrome which can affect bones and joints in people with diabetes and neuropathy.

Advantages of a TCC

• Recognised as the gold standard treatment for offloading neuropathic diabetic foot ulcers and CN.
• It should help your wound to heal quicker.
• If you have CN or a fracture, it is the best way of keeping the bones in your foot supported.

Disadvantages of a TCC

• It may rub and cause other wounds on your foot or leg.
• You may not be able to work while in the cast.
• You will not be able to drive a manual car while in the cast.
• If you have an automatic car you may be able to drive, however, you should check with your insurance company and the DVLA.

Instructions when wearing a TCC

• You will need to attend the foot clinic every seven to14 days to have the cast changed.
• Do not try and remove the cast yourself.
• You can walk and put weight through your cast, unless you have specifically been told not to by the podiatrist or doctor.
• Too much walking in the cast can increase the risk of a rub or delay healing, therefore we advise to try and keep this to a minimum and elevate your leg when possible.
• Wear the cast sandal provided at all times when walking.
• If you need crutches to help you, please let the podiatrist know.
• Check your cast daily for signs of damage.
• Do not put anything down or inside the cast.
• Check the skin around the top of the cast and on your other foot and leg for any signs of rubbing.
• If needed, a large sock can be worn on your other leg to prevent rubbing from the cast in bed at night.
• Do not get the cast wet. You can purchase a waterproof cast cover from most pharmacies or online if you wish to bathe or shower.
• You will not be able to travel by aeroplane if you have a cast on.
• You may need to be in the cast for many months and in some cases over a year.

Possible problems which can occur

• Discomfort, rubbing or pain.
• Smelly.
• Cracking.
• Stained or wet.
• Feels too tight or too loose.
• Has become soft.

If you feel unwell or have flu like symptoms – shivery, tired and/or hot – or there is anything else about your cast which is worrying you, please contact the foot clinic. Out of hours, call 111 or go to your nearest A&E.

A rare complication which may occur because of the reduced mobility and weight bearing caused by wearing a cast is a deep vein thrombosis (DVT) or pulmonary embolism (PE). These are blood clots in your leg (DVT) or lung (PE).

Symptoms may include:

• increased or renewed pain in the leg or back of the calf
• shortness of breath
• sharp chest pain which gets worse when you breathe in
• coughing up blood.

The foot team will discuss these possible problems with you and what you can do to reduce your risk. If you are concerned about a DVT or PE please seek urgent medical help. Go to your nearest A&E or dial 999.

Useful information

• Blood clots: www.nhs.uk/conditions/blood-clots/
• Thrombosis UK: www.thrombosisuk.org