Total contact casting: Information and advice

This leaflet has been designed to give you advice about your total contact cast (TCC). Please read it carefully.

What is a TCC?

A TCC is an enclosed non-removable cast. It is used to redistribute pressure on the foot and can be used to treat diabetic foot ulcers, foot fractures, post-surgery wounds and Charcot neuroarthropathy (CN); an inflammatory syndrome that can affect bones and joints in people with diabetes and neuropathy.

Advantages of a TCC

• A TCC is recognised as the gold standard treatment for offloading neuropathic diabetic foot ulcers and CN.
• A TCC should help your wound to heal quicker.
• If you have CN or a fracture, a TCC is the best way of keeping the bones in your foot supported.

Disadvantages of a TCC

• A TCC may rub and cause other wounds to your foot or leg.
• You may not be able to work whilst in the cast.
• You will not be able to drive a manual car whilst in the cast.
• If you have an automatic car you may be able to drive; however, you should check with your insurance company and the Driver and Vehicle Licensing Agency (DVLA (opens in a new tab)).

Instructions for when wearing a TCC

• You will need to attend foot clinic every seven to 14 days to have the cast changed.
• Do not try to remove the cast yourself.
• You can walk and put weight through your cast, unless you have specifically been told not to by the podiatrist or doctor.
• Too much walking in the cast can increase the risk of a rub, or delay healing, therefore it is advised to try and keep this to a minimum and elevate your leg when possible.
• Wear the cast sandal provided at all times when walking.
• If you need crutches to help you, please let the podiatrist know.
• Check your cast daily for signs of damage.
• Do not put anything down/inside the cast.
• Check the skin around the top of the cast and on your other foot and leg for any signs of rubbing.
• If needed, a large sock can be worn on your other leg to prevent rubbing from the cast in bed at night.
• Do not get the cast wet. You can purchase a waterproof cast cover from most pharmacies or online if you wish to bath or shower.
• You will not be able to travel by aeroplane if you have a cast on.
• You may need to be in the cast for many months, and, in some cases, for more than a year.

Possible problems that can occur with your cast

– Rubbing – Has become soft – Pain
– Cracking – Is stained or wet – Discomfort
– Feels too tight/loose – Has started to smell

If you feel unwell or have flu like symptoms (shivery, tired and/or hot) or there is anything else about your cast that is worrying you please contact the foot clinic or plaster room straight away. Go to the emergency department (ED) if out of normal working hours.

A very rare complication which may occur because of the reduced mobility and weight bearing brought about by wearing a cast is a deep vein thrombosis (DVT) or pulmonary embolism (PE). These are blood clots in your leg (DVT) or lung (PE).

Symptoms may include:

• increased or renewed pain in the leg or back of the calf
• shortness of breath
• sharp chest pain which gets worse when you breathe in
• coughing up blood

The foot team will discuss these possible problems with you and what you can do to reduce your risk.

If you are concerned about a DVT or PE please seek urgent medical help; go to the Emergency Department directly or dial 999.