# Total contact casting > A total contact cast is a close-fitting, non-removable cast that takes pressure off a foot ulcer. It's mostly used for ulcers on the sole of the foot in people with diabetes. It heals more ulcers than removable options, but it isn't suitable for everyone and needs regular checks. Guide in [Treatments](https://footanklelowerlimb.com.au/learn/topics/treatments), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/total-contact-casting Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **It's a close-fitting cast you can't take off.** It takes pressure off a foot ulcer by sharing your weight across the whole foot and up your leg. - **It works best for ulcers on the sole of the foot in people with diabetes,** where it heals more ulcers than removable options. - **It isn't for everyone.** Infection, severe poor circulation or severe swelling usually rule it out. - **Treatment can last many months,** with regular clinic visits to change the cast. - **Check the cast every day,** and contact your foot team or GP the same day if anything seems wrong. The signs are listed at the end. Toes that turn blue or white in the cast need the nearest emergency department. ## What is a total contact cast, and how does it work? A total contact cast (TCC) is a shell that fits your leg and foot closely and touches the whole foot [1]. It spreads your weight across the whole foot and up onto your leg, which takes pressure off the sore area [1][2]. Unlike a removable boot, it can't be taken off easily, so the pressure stays off the ulcer all the time [3]. That matters because a device only helps if it's worn. Non-removable knee-high devices are worn far more consistently than removable ones [4]. ## What is it used for, and how well does it work? Its best-supported use is healing ulcers on the sole of the forefoot or midfoot in people with diabetes and neuropathy (loss of feeling). For these, non-removable knee-high devices, including TCCs, heal more ulcers than removable devices and therapeutic footwear [4]. They also beat dressings alone [5]. Guidelines recommend them as the first choice [6]. Some evidence supports them for forefoot ulcers with mild infection or mildly reduced blood flow, but for ulcers elsewhere on the foot it is very limited [4]. TCCs are also used for Charcot foot (an inflammatory condition that can affect the bones and joints in people with diabetes and neuropathy), foot fractures and wounds after surgery [7]. It isn't clear yet how well they work for these, so the decision rests on your clinician's judgement. Healing time varies, and treatment can run for many months [8]. Keeping the cast on and attending every change matters a great deal [4]. An ulcer that doesn't heal is linked with more serious problems, including amputation [9], which is why a slow ulcer needs review. ## Is it right for me? It suits people with diabetes who have a neuropathic ulcer on the sole of the forefoot or midfoot, with no infection [5]. It isn't suitable if you have a soft tissue infection, a bone infection (osteomyelitis), severe poor circulation or severe swelling of the lower leg or foot [5]. Expect a check of your circulation and of the ulcer for infection before casting. Reduced blood flow limits its use. With mild to moderate peripheral arterial disease it may still be possible, but only after a vascular assessment (a check of your circulation) and with close follow-up [10]. If a non-removable cast isn't suitable or you can't tolerate it, a removable knee-high or ankle-high device is the usual second choice [6]. Tell your team if you're unsteady on your feet, have limited mobility, or think you won't cope with a cast that stays on. ## What happens during casting? A trained clinician applies the cast, so it isn't something to put on or take off yourself [5]. Your podiatrist will first remove hard skin and dead tissue around the ulcer [11]. The cast usually goes on from toes to knee and takes about 20–30 minutes [2]. Expect regular visits, often weekly, to remove the cast, check your foot and reapply it [2]. Changes may be every one or two weeks at first, so the cast doesn't loosen as swelling goes down [8]. While you're wearing it, keep it dry, so no bathing [5]. Don't push objects or powder down it, don't dry it with a hairdryer, and don't drive [8][12]. The cast makes you less steady. Walking less, using crutches, and using a walking frame if you were unsteady already can help [1]. > [!tip] Try this > Each day, check the skin around the cast edges and your toes, or ask someone to look for you. At bedtime, put a thick, soft knee-high sock on your other leg to protect it from the cast. ## What are the risks and side effects? The main problems are infection, skin softened by moisture (maceration) and abrasion [13]. The cast can also rub and cause new wounds elsewhere on your foot or leg, and with neuropathy you may not feel it [2]. Skin irritation is reported, and you can't check the ulcer yourself each day [5]. The cast can make you less steady and raise the risk of falls [1]. It can disturb sleep [5], and it can rub the skin of your other leg at night [1]. Because the cast leg is longer, walking too much can cause hip or back pain [1]. If you're at higher risk of pressure ulcers, change your leg's position about every two hours [8]. Wearing a cast can also raise the risk of blood clots in the leg [2]. ## How does it compare with other options? Non-removable knee-high devices heal more ulcers than removable devices and ordinary therapeutic footwear [4]. A TCC and a non-removable walking boot work equally well [4]. The main advantage is that a cast can't be taken off, so you keep wearing it [3]. A removable walker is easier to apply, and it lets your team check the ulcer and change dressings more often, but it's easy to take off [5]. Removable knee-high and ankle-high devices work equally well as each other, and may heal ulcers better if you wear them whenever you stand or walk [4]. If offloading doesn't heal a forefoot ulcer, your team may discuss surgery to reduce pressure on it [6]. ## When to see a podiatrist Check your cast every day, or ask someone to, because reduced feeling means problems can go unnoticed [2]. Never try to remove the cast yourself. Call 000 and ask for an ambulance if you have chest pain, sudden severe breathlessness, chest pain that's worse when you breathe in, or you cough up blood, because a clot can reach the lungs [7]. Also call if a foot infection brings confusion or slurred speech, severe shivering or muscle pain, passing little or no urine, or mottled skin. Go to the nearest emergency department if your toes turn blue or white in the cast, or if a foot infection is spreading fast and you have a fever and feel very unwell. See your GP or a podiatrist the same day if you notice: - a cast that's loose, tight, dented, cracked, soft, wet or smelly [2]; - discharge, blood staining, new rubbing or pain, or a wound, sore, blister or colour change on your foot [2]; - spreading redness, heat, swelling or pus; - a fever, flu-like symptoms, or a temperature above 38.3ºC or below 36ºC [11]; - new or increasing calf or thigh pain or swelling, or a calf that's hot, swollen and painful [2]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. See your podiatrist if your ulcer isn't getting smaller over your visits. A repeat circulation check is recommended when a wound isn't progressing [10]. If you have an ulcer on the sole of your foot and diabetes, ask your foot team whether a non-removable device such as a TCC suits you. ## Common questions ### Can I shower or bathe with the cast on? No. The cast has to stay dry and in place, so bathing isn't allowed. Keep it dry at all times, and don't use a hairdryer on it or push objects or powder down inside it. Ask your foot team about the safest way to wash while you're wearing it. ### Can I drive while wearing the cast? You'll be advised not to drive while wearing it. The cast also makes you less steady, and leaflets list not being able to drive a manual car as a drawback. Ask your foot team about other ways to get to appointments and around home. ### Why can't I take the cast off myself? The cast works because it stays on, which keeps pressure off the ulcer all the time. Taking it off yourself would undo that, and it could harm your skin. A trained clinician applies and removes it, usually at regular visits, and checks your foot each time. ### Will I need time off work? Some people do. The cast limits walking and driving, and you'll need regular clinic visits, often weekly. How much time you need depends on your job and how much you're on your feet. Talk to your foot team early, so you can plan around your visits. ## Further reading - [Total contact casting on Clindice](https://clindice.com/total-contact-casting) - [Charcot Foot](https://www.uhsussex.nhs.uk/wp-content/uploads/2023/02/Diabetic-Charcot-Foot.pdf), NHS - [Diabetes - foot ulcers: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000077.htm), MedlinePlus - [Total contact casting: Information and advice](https://www.cuh.nhs.uk/patient-information/total-contact-casting-information-and-advice/), NHS - [Advice for Patients with a Total Contact Cast (TCC)](https://dchft.nhs.uk/leaflets/advice-for-patients-with-a-total-contact-cast/), NHS - [NHS HIGHLAND BEST PRACTICE DFU AND FU PATHWAY AND STANDARDS OF CARE: A VIP APPROACH](https://www.nhshighland.scot.nhs.uk/media/de5jy4yl/best-practice-foot-ulcer-pathway-standards-of-care.pdf), NHS ## Sources 1. Information for Patients · NHS. https://www.qehkl.nhs.uk/documents/Diabetes/Your%20feet/Total%20Contact%20Cast.pdf 2. Podiatry - Non-removable Cast · NHS. https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/podiatry-non-removable-cast 3. Offloading of Diabetic Neuropathic Plantar Ulcers: Secondary Analysis of Step Activity and Ulcer Healing · Wendland DM, Kline PW, Bohnert KL et al. · Advances in Skin & Wound Care · 2023. https://doi.org/10.1097/01.asw.0000919476.24220.cc 4. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review · Lazzarini PA, Jarl G, Gooday C et al. · Diabetes/metabolism Research and Reviews · 2020. https://doi.org/10.1002/dmrr.3275 5. Pressure-relieving interventions for treating diabetic foot ulcers · Lewis J, Lipp A · The Cochrane Database of Systematic Reviews · 2013. https://doi.org/10.1002/14651858.cd002302.pub2 6. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update) · Bus SA, Armstrong DG, Crews RT et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3647 7. Total contact cast · Kent Community Health NHS Foundation Trust · 2024. https://www.kentcht.nhs.uk/leaflet/total-contact-cast/ 8. Advice for Patients with a Total Contact Cast (TCC) · Dorset County Hospital. https://dchft.nhs.uk/leaflets/advice-for-patients-with-a-total-contact-cast/ 9. Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers · Zhang J, Sadek M, Iannuzzi L et al. · Vascular and Endovascular Surgery · 2025. https://doi.org/10.1177/15385744241301171 10. Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review · Tickner A, Klinghard C, Arnold JF et al. · Wounds · 2018. https://pubmed.ncbi.nlm.nih.gov/29481330/ 11. Looking after your diabetic foot ulcer to reduce the risk of amputation · Information Site · 2025. https://mydiabetesmyway.scot.nhs.uk/resources/internal/looking-after-your-diabetic-foot-ulcer-to-reduce-the-risk-of-amputation/ 12. Health Education Leaflet Diabetic Foot Clinic Total Contact Cast · NHS. https://www.nnuh.nhs.uk/publication/download/total-contact-cast-leaflet-for-people-with-diabetes-v4/ 13. Treatment of the diabetic foot by offloading: a systematic review · Martins de Oliveira AL, Moore Z · Journal of Wound Care · 2015. https://doi.org/10.12968/jowc.2015.24.12.560 --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.