Total Contact Cast (TCC)

What is a TCC?

A TCC is the recognised gold standard treatment for Diabetic foot ulceration and Charcot foot. The cast is designed to reduce the pressure on your foot, by offloading weight onto your leg. The cast is made from soft cast (a flexible fibreglass material).

Why do I need to wear a TCC?

ne of the main reasons for failed healing of Diabetic foot ulcers is continued trauma to the area affected, which often occurs during the normal activities of daily living with a foot that has reduced sensation. The TCC aims to reduce pressures on the bottom of the foot.

Alternatively, you may have been diagnosed with an active Charcot foot. In this case, the cast is designed to keep the foot fixed, in an attempt to stop deformity occurring.

Instructions for patients wearing a TCC

• Rest and elevate your leg as much as you can. Keep your number of steps to 500 or less per day if possible.
• Do not try to remove the cast yourself.
• Wear the walker boot provided for you at all times when you are walking.
• Check your cast every day for signs of damage and any signs of rubbing.
• Check the skin on the other foot and leg for rubbing. To prevent rubbing on your other leg when in bed, you can use a pillow case to cover the cast.
• Check your blood sugar levels regularly.
• Do not poke anything down the cast as this could damage the skin under the cast and cause infection or further pressure sores.
• Do not get the cast wet. You can get a plastic cover for the cast, which will keep it dry while you shower.

Further information

• The cast may rub and cause further ulceration to your foot or leg.
• You may need to wear the cast for months. In some cases, over a year.
• You may need to come to the clinic every week to have the cast removed and reapplied.
• You may need to be off work while wearing the cast.
• You will not be able to drive a manual car while wearing a cast. If you have an automatic car, you should check with your insurance company if you are covered to drive.
• It is not recommended to travel abroad whilst you have a diabetic foot problem. You should seek advice from your airline if you are planning to fly. You should also inform your travel insurance company about your foot problem before you travel.

Are there any possible complications when using a TCC?

A possible serious complication when wearing a cast is a deep vein thrombosis (DVT) or pulmonary embolism (PE). These are blood clots in the leg (DVT) or lung (PE).
Symptoms include:

• increased or new pain in the leg;
• pain in the calf rather than over the ulcer site;
• shortness of breath;
• a sharp pain in the chest which is worse when you breathe in; and
• coughing up blood.

If you experience any of the above, you must seek urgent medical help. Either go to the Emergency department or dial 999.

Ring the Hot Foot Phone for advice immediately if:

• you notice the cast has caused a rub or made any part of your foot bleed;
• you feel unwell, tired, hot, shivery with flu like symptoms as this might mean that you are developing an infection;
• you have excessive pain, pins and needles or poor circulation in your foot or leg;
• your cast becomes loose, tight, stained, wet, soft, cracked or starts to smell badly; and
• there is anything about your cast that is worrying you.

Contact details