Tan Tock Seng Hospital1
The total contact cast (TCC) is considered the gold standard treatment for a neuropathic plantar diabetic foot ulcer (DFU). However, it remains grossly underutilised.
The aims of this study are to report on the healing outcomes of DFU patients treated with TCC, cast-related adverse events (AEs) and wound recurrence rate after TCC.
We performed a retrospective analysis of patients with plantar DFUs seen at Tan Tock Seng Hospital Podiatry department for TCC management from January 2020 to May 2021.
A total of nine patients were identified. Three patients healed while six others stopped treatment due to cast complication, mobility issues or wound infection. In patients who ceased casting prematurely, a wound size reduction of 0% to 87% (median 35%) after casting duration between 6 to 18 days (median 7.5 days) was noted. Three patients experienced cast complications which resolved without surgical intervention or hospital admission. Two patients experienced wound recurrence after TCC cessation and underwent repeat casting.
The outcomes of our study support the efficacy of TCCs for wound healing. Although majority of patients were unable to tolerate a TCC until wound closure, some cases demonstrated substantial wound size reductions.
Although the use of TCCs is associated with a small risk of pressure wounds, weekly reviews, casting technique refinements and patient education are able to minimise such occurrences.
TCCs can be a safe and effective offloading modality for healing of chronic plantar foot wounds. More emphasis should be placed on casting as first line treatment instead of a last resort.