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Offloading & Total Contact Casting

Specialized casting to redistribute pressure and force the healing of diabetic foot ulcers.

How offloading & total contact casting works

Healix360 supports access to advanced mobile wound care services for patients throughout our coverage area. Services are delivered by licensed physicians and nurse practitioners experienced in the evaluation and management of chronic and complex wounds. Care is coordinated and provided directly to patients in private residences, assisted living communities, and skilled nursing facilities. A diabetic foot ulcer on the bottom of the foot will never heal if the patient continues to walk on it, driving the tissue into the bone with every step. TCC works by redistributing the patient's weight away from the ulcerated area and dispersing it evenly across the entire surface of the lower leg and foot. Furthermore, because the cast is non-removable, it enforces 100% compliance, physically preventing the patient from walking unprotected.

When it may be used

A licensed clinician determines whether this treatment is appropriate after evaluating the wound and the patient's medical history.

  • Plantar (bottom of the foot) diabetic foot ulcers.
  • Neuropathic ulcers where the patient cannot feel the ongoing trauma.
  • Charcot neuroarthropathy (specialized stabilization).
  • Patients who are non-compliant with removable offloading boots.

When it may not be appropriate

Treatment decisions are individualized. Potential contraindications and precautions may include:

  • Active, untreated deep space infection or osteomyelitis.
  • Severe peripheral arterial disease (inadequate blood flow to heal or tolerate the cast).
  • Deep ulcers with narrow tracts that require daily inspection.
  • Severe fluctuating edema.

What to expect

After wound care is performed, the clinician will carefully wrap your foot and leg in protective padding, paying special attention to bony prominences. They will then apply a lightweight fiberglass cast material. Once dry, you will be given a cast shoe to allow safe, limited mobility. The cast is typically cut off with a specialized saw and reapplied by the clinician every 1 to 2 weeks as the swelling decreases and the wound heals.

Evidence and clinical context

According to the American Diabetes Association and multiple meta-analyses, Total Contact Casting yields significantly higher healing rates (often >85% closure in 12 weeks) and faster healing times for diabetic foot ulcers compared to any other offloading modality, primarily due to enforced patient compliance.

Frequently Asked Questions

Why can't I just use a removable walking boot?

Clinical studies show that patients only wear removable boots for about 30% of their daily steps. Because you have neuropathy, you do not feel the damage occurring when you walk to the bathroom at night without the boot. TCC ensures the foot is protected 100% of the time.

Is the cast heavy?

No. Modern Total Contact Casts are made of highly advanced, lightweight fiberglass or specialized roll-on casting materials, making them much lighter and easier to walk in than traditional plaster casts.

Can I drive with a Total Contact Cast?

No. You cannot safely operate a vehicle with a cast on your right foot, as it severely impairs your ability to feel and utilize the pedals. If the cast is on your left foot, you should still consult your physician regarding safety.

How do I bathe with the cast on?

The cast must remain completely dry. You will need to use a waterproof cast protector (a specialized heavy-duty plastic sleeve) when showering, or take sponge baths while keeping the leg outside the tub.

What if the cast feels loose or rubs?

As your leg swelling decreases over the week, the cast may begin to feel loose. If you experience rubbing, pistoning, or new pain, you must contact our clinical team immediately so the cast can be removed and replaced to prevent new sores.

Call 877-545-1300 or request a provider to begin care. Healix360 serves Southern California and Nevada and accepts Medicare Part B and most major insurance plans.