Total contact casing

Abstract

Foot ulcerations are the most common complications associated with the patient living with diabetes worldwide, and South Africa is no different. Several total contact casing methods worldwide are available. The description of the application of a total contact cast (TCC) with plaster bandage (Gypsona^®), as described in Levin and O’Neal’s The Diabetic Foot is probably the most well known.¹ Undisputedly, total contact casing is regarded as the gold standard offloading method used for the rapid healing of neuropathic plantar foot ulcers.^1,2 Numerous studies and papers indicates its effectiveness.^1-4 Unfortunately, total contact casing is still underused in the South African environment and other offloading devices, such as felt padding in shoe inserts, are used primarily.⁵ Several reasons for this have been discussed with peers and other healthcare professionals. The most common seems to be “the fear of failure”. Health professionals are uncertain as to how to apply the TCC, and are worried that they will cause more harm than good. From this, it is clear that guidance and education are needed, including skills training, in order to change this perception. It has been shown in several studies that total contact casing is safe for the patient in skilled hands.^2,6