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

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.

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.

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.

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.