Intended use of Total Contact Casts
Total Contact Casts are typically intended for diabetic planter ulcers.
Hold or don’t initiate a Total Contact Cast if:
1. Infection
2. Critical limb ischemia Tcom < 30mmHg
3. Major illness / Unstable patient
4. Frail / Bad hip or back
5. Non-compliance (overactive)
Quick Fixes for Total Contact Cast Complications:
1. Heavy Drainage – Biweekly changes
2. Toe Drainage – Open toe cast
3. Discomfort – Add padding
4. Chafed skin - Add padding
5. Pre-ulcerated lesion on pressure point – offload pressure point
6. New ulcer – offload pressure point
Consider a DH Walker if you are unable to control for: 
1. Discomfort with extra padding
2. Chafed skin with extra padding
3. New ulcer formation continues regardless of offloading
4. Lower extremity joint problems
Note: DH Walkers are hard to ambulate in for patients with a weak gait. If this is the case consider a walker. If it is still difficult for the patient to ambulate consider a wedge shoe (Darco).
Note: Consider a Crow Boot for patients who have a rocker bottom (Charcot) foot deformity.
