Total contact casting: A forgotten art in the management of neuropathic foot ulcers

Abstract

Background: Neuropathic ulcers affect a patient's ambulation and are the leading cause of nontraumatic amputations. Offloading (reduction of pressure) is the key to success in managing these ulcers. Total contact casting (TCC) is considered as the gold standard of treatment for managing neuropathic foot ulcers (NFU). However, this method is less frequently used in the present-day ulcer management due to the lack of skill and laborious nature of work involved. Aim: This study aims to explore the merits and demerits of this technique and understand its relevance in modern times in managing NFUs. Patients and Methods: A total of 24 patients with NFU of different etiologies presented to outpatient unit between August 2018 and August 2020 were included in this prospective case series. All the patients were treated with TCCs applied at weekly intervals, until the ulcer healed completely. Results: Primary outcomes measured were number of casts required which reflected the time of healing in weeks. The mean number of castings required for each centimeter of ulcer healing was 2.310 cast time duration with a 91.66% percentage of success rate. Ulcers in all the patients healed on or before 16 weeks with a mean duration of healing of 58 days after commencement of treatment. Conclusion: It offers attractive healing rates in the management of NFUs and is associated with fewer manageable low-risk complications. Surgeons should incorporate this casting method as part of standard care of NFU to produce early healing and avoid major complications secondary to poor wound healing.

Keywords

• brodsky classification
• neuropathic foot ulcer
• offloading
• total contact casting