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Total contact casting (TCC) is considered the gold standard in treating diabetic foot ulcers (DFUs). Since patients with diabetic neuropathy cannot feel injuries on their feet, DFUs must be caught early because, left undertreated, they can lead to lower extremity amputations (non-traumatic) in this population.  Studies show five-year survival rates among patients with diabetes who undergo above or below the knee amputations to be as low as 28%.  Alternatively, the use of TCCs results in a DFU healing rate above 85%.

One of the primary benefits of using TCCs to treat DFUs is offloading. Even with top notch care, healing may be delayed if the patient continues to apply pressure via walking on the DFU.  TCCs promote healing by taking pressure off the ulcer and the other areas of the foot most prone to injury.  The provider applies the layers of the casting in close contact with the foot and leg, which prevents movement in the cast. This close contact distributes the patient’s weight over a larger area, including the lower leg. 

After the initial change in 3 – 5 days, a TCC is typically changed every 1- 2 weeks, depending on the amount of swelling, healing rate, and patient tolerance. TCCs are discontinued when healing has occurred.

TCCs should be a first line of defense against DFUs, not the treatment of last resort.  Rapidly healing DFUs, even small ulcers, helps to prevent amputations and reduce mortality rates.