Total Contact Cast

[RachRN11]

I have a patient that we don't know what to do with. She is limited in her mobility so TCC may be a safety issue (more falls) but she isn't compliant with keeping pressure off her heel.

How often do you use a total contact cast on a diabetic heel (plantar surface) ulcer? If you do use TCC, how often is the wound successfully healed?

Thanks!

[Candogal]

I love the TCC for diabetic patients, the wounds heal so much faster we have had a lot of success. The casts are changed weekly but a patient at risk for falls would not be a good candidate.

[Wicked Wahine]

We use TCCs a lot in my clinic for plantar diabetic foot ulcers. As long as the wound is not deep, not infected and not too wet, it usually has good outcomes. In my experience (1.5 years of using TCCs now), the best outcomes are with pts that keep their sugars under control and still offload as much as possible. You mention though that this pt is a fall risk, is it your and the physician's opinion that she can be compliant with using her walker or wheelchair 100% of the time? Because yeah, the TCC really does mess with ambulation and it takes a regular walky-talky a good week to get the hang of it. A non-healing ulcer is frustrating as well as a non-compliant pt, and a TCC would be a great temptation in such a situation but safety has to come first. Broken hip vs non-healing DFU. It's lame, but it is what it is.

[yesitslaura]

There are other options than the TCC for off loading, and chances are this patient may very well get another ulcer even if this one heals. You may look at more long term options, like a special shoe or T brace. I would probably refer this patient to a podiatrist so she can get a specialized recommendation.