Casting Q&A

What is a Total Contact Cast?

A Total Contact Cast is a rigid shell made from fiberglass wrapping material (other materials such as plaster are often used as well). This material is wrapped around your foot, ankle, and lower leg. It follows the shape of your leg very closely. It is wrapped snugly so that it will not slide and cause you discomfort.
Underneath the rigid shell is specialized padding to protect your leg and foot from pressure and friction. Some casting systems also include an “L” shaped splint for added support and stability. A walking surface is attached to the bottom of the cast to enable you to walk as needed comfortably and safely.

Why Do I Need A Total Contact Cast?

Sometimes, people develop ulcers on the soles of their feet due to pressure, traumatic injury, or other Diabetes complications such as Diabetic Neuropathy or Charcot Foot. Walking on these ulcers can harm them or delay healing.

A Total Contact Cast can help to reduce the pressure on the bottom of your foot when you walk. This is commonly referred to as “off-loading”. It can also spread out the pressure along the entire surface of your foot. The Total Contact Cast has been recognized as the “Gold Standard” for off-loading diabetic foot ulcers.

How Does a Total Contact Cast Work?

Each time you take a step, your entire body weight impacts the sole of your foot. Over time, this pressure can delay or prevent your diabetic foot ulcer’s ability to heal properly.

The Total Contact Cast is made to fit closely to the contours of your foot and leg. The rigid cast wall, specialized padding, walking surfaces, and a posterior splint all serve to take most of the pressure away from the bottom of your foot and move it to your lower leg and calf when you walk. The close fit also helps to spread out the remaining pressure evenly across the sole of your foot.

What Can a Total Contact Cast do for Me?

A Total Contact Cast allows you to walk when needed without having to put on a specialized boot or other medical device beforehand.

A Total Contact Cast can help to protect your ulcer and the rest of your foot from additional injury all day and all night long.

A Total Contact Cast is generally considered by medical professionals to be the “Gold Standard” in off-loading treatments for Diabetic Foot Ulcers. Reviews of thousands of patient experiences demonstrate a reduced rate of amputation when total contact casting is utilized.

How Much Can I Walk in a Total Contact Cast?

A Total Contact Cast allows you to walk as needed. The less you walk, however, the less pressure you put on your ulcer. Reduced walking can lead to faster healing. Try to limit your walking each day to one-third of your normal activity.

Can I get My Total Contact Cast Wet?

Keep your cast dry. Water on or inside your cast can damage the cast and your skin or wound. Use a cast cover, plastic bag or other waterproof item when you bathe/shower.

Can I Drive with a Total Contact Cast?

DO NOT attempt to use the leg which is casted to drive or operate the pedals of any vehicle or moving equipment.

Is Casting Safe for our Patients?

The TrueKast has patent-pending technologies that address safety – The QuickSaw Removal System (No Cast Saw needed), The Total Foot Protection System (an all-encompassing Foam Cushioning System for the Foot and Tibia), and The Traction Stability System (specialized walking surfaces with “Lock and Walk” technology and a rocker bottom design) to provide safety and confidence during ambulation.

Can I Convince My Patients to Let Me Cast?

TrueKast’s light weight (<38oz.), comfortable foam padding, and specialized walking surfaces offer a cast that is more acceptable to patients.

Can’t we use Removable Devices?

In a study on removable off-loading devices (cast walkers, DARCO shoes, etc.), patients were shown to wear the devices only 28% of the time. One of the reasons a Total Contact Cast is considered the “Gold Standard” of Offloading is that it is provides 24 hour a day Offloading by enforced compliance.

Is Casting too Complicated for my Staff?

TrueKast provides a simple, fast, and staff-friendly option for off-loading. It’s all-in-one, pre-cut, and pre-formed design makes casting effortless. There is no need for pre-cut tape, extra materials, a cast saw, or a boot. Wrapping the Cast Tape is similar in technique to wrapping an Ace Wrap.

Who will Train our Staff to Cast?

WoundKair Concepts offers extensive hands-on education, including a Certificate of Training Completion, for your staff.

Does Casting Slow Down the Clinic?

The TrueKast can be removed, applied, and cured to weight bearing all in less than 20 minutes WITHOUT THE USE OF A CAST SAW. This is up to two times as fast or more than a traditional plaster cast or traditional contact cast.

How do I Pick the Right Size Cast for my Patient’s Leg?

The TrueKast is a Traditional Total Contact Casting System consisting of materials that are pre-formed, self-adherent, and wrapped around your patient’s foot and leg – One Size Fits All.

How Do I Choose the Best Walking Surface for my Patient?

The Large Foot Plate is best for most of your patients (size 8 shoe or above). The TMA Foot Plate is for patients who have had a Trans Metatarsal Amputation. The Small Foot Plate is for the smallest feet (under size 8). The Cast Shoe Option is for patients with heightened stability issues or those that require a large flat surface.

How High on the Leg Do I Pad the Skin?

The Stockinette should go up to approximately 3 inches below the bottom of the Kneecap. The cast should never cover the Tibial Tuberosity.

How High on the Leg do I Wrap the Cast?

The Fiberglass portion of the cast should not extend above the widest portion of the leg (generally this is the widest part of the calf).

Do I need Extra Padding for the Leg or Foot?

The TrueKast Total Contact Casting System contains all the padding normally needed for the Leg and the Foot.

Do I Need to Pad the Wound?

The TrueKast Total Contact Casting System contains the Total Foot Protection Pad which will cover the entire Plantar Surface of the wound with a thick layer of protective, high density foam padding.

What Type of Dressings Should I use Under the Cast?

Dress the wound in the same manner that you would normally dress it without the cast. Make sure the dressing is absorbent enough to handle the drainage for the length of time you will be leaving the cast on the patient.

How Often should I Change the Cast?

When a patient receives their first cast, the cast should be changed in 48 – 72 hours to ensure inspection of the leg and foot and how well the patient is responding to the cast. Afterwards, a Total Contact Cast may be left in place up to 7 days maximum. The Cast should be changed more frequently if the wound drainage or patient activity requires more frequent casting.

How Long Does the Cast Take to Dry?

The TrueKast is weightbearing 8 minutes after it has been applied.

What do I do if I need More Cast Tape?

The TrueKast contains enough materials to cast most patients up to 7 feet tall and up to 350 pounds without extra materials. For patients of extraordinary size or weight, extra materials may be purchased via the TrueKast Convenience Kit. It contains extra Cast Tape, Splinting material, foot plate, support plate and other items.