Total contact versus Total contact Softcast in treatment neuropathic plantar ulcers.

A Total Contact Softcast (TCS) is a new alternative treatment for patients with a forefoot ulcer.

An increasing number of Hospitals in the Netherlands use a TCS or the Total Contact Cast (TCC):

the golden standard for off-loading. Patients have a better comfort in a TCS instead of a TCC,

resulting in an easier walking pattern. Cast technicians observe adequate healing of the wounds.

A comparison between both techniques was never made (to our knowledge). A TCS relieves

multiple possible causes prohibiting mobilization. It may shorten the treatment duration and

increase the quality of life.

The impact of excessive pressure on the sole of the foot in the pathogenesis of neuropathic

plantar ulcers, is well established. It is also known that complete relief of pressure from the

ulcerated area is the key to effective healing. A non-removable Total Contact Cast is the golden

standard for off-loading ulcers located at the forefoot or midfoot. Patients walk for weeks or

several months with a TCC: After 12 weeks resulting in 90% healing of the patients’ wounds.

This non-removable knee-high device, including ankle joint immobilization, reduces the activity

level with a potential risk of falls and knee or hip complaints due a provoked asymmetry in

walking. Early discontinuation because of inconvenience of the TCC was seen in 21% of the

patients. The use of a TCC is contraindicated, in patients with infection or critical ischemia.

A relative contraindication is found in elderly, patients with visual or equilibrium problems, and

patients with a contra lateral foot ulcer or varicose veins. Other reasons for discontinuation are

pressure points and joint problems in 7% of the patients. Also ankle stiffness and lower back pain

disturb the walking pattern.

In a Total Contact Softcast the ankle is wrapped in a semi-rigid stretch bandage allowing

movement of the ankle joint. The sole is constructed of a rigid cast. This allows a normal walking

pattern combined with off-loading of pressure points of the wounds. The World Health

Organization (WHO) defines disability as one of the problems an individual may experience in

functioning. This may be positively influenced by the accomplishment of a physically active

lifestyle with a semi-rigid cast: A TCS.

A TCS is comparable to TCC and an effective treatment in neuropathic forefoot ulcer,

patients visit the outpatient clinic weekly for a cast change and wound inspection by a wound nurse.

Total Contact Cast