Total-contact casting, sandals, and insoles. Construction and applications in a total foot-care program

It must be stressed that these tools do not exist in a vacuum and that no single tool is particularly useful unless it is a part of a comprehensive, lifelong foot-care program. A partnership between the health care provider and the patient is essential in making any of these techniques useful. On the positive side, a program incorporating these techniques can be very successful with even the most difficult population. The very successful Parkland Memorial Hospital program provides care for a county hospital population that is often difficult in terms of compliance. Without question, the reasons for incorporating such a program in a public facility are sound. Amputations are avoided; and patients remain or become more functional, thus decreasing hospital cost and patient morbidity and mortality and increasing the patient's potential for contributing to society. Similarly, in private facilities, once the program is established, costs need not run high and considerable amounts can be saved by helping heal and/or prevent the horrendous sequelae of diabetic neuropathies.