Total Contact Cast

Dr. Vincent Giacalone

Dr. Vincent Giacalone

Podiatric Medicine & Surgery

466 Hook Rd., Suite 24D, Emerson, NJ 07630

Phone: 201-261-0500

Total Contact Cast

What is a total contact cast?

The total contact cast helps heal foot sores/ulcers and Charcot fractures because it protects the skin of the foot and reduces the weight/pressure which is being put on the foot. The total contact cast is a fiberglass shell designed so you may place pressure on it. The cast fits your leg and foot very closely. It touches or is in contact with your whole foot and leg–that’s why it’s called a total contact cast. It’s used to treat ulcers (sores) on the feet and Charcot joint fractures. The cast has only a small amount of padding around your foot. However, where the cast fits under the sore, there is a layer of soft foam that makes a space so that no pressure is put on the sore. The extra padding for the sore protects the sore and helps it tot heal. Some padding is applied to the front of the leg and around the ankle bones.

Why do I need a cast?

The cast will help your sore or the fractures heal. The sore on your foot goes from the surface of your skin down into the deeper tissues. Sores like this are caused by pressure on bony points under your foot as you walk. You probably did not feel the injury when it started because of nerve damage caused by your diabetes. If you keep walking without the cast, your sore or fractures won’t heal. The cast takes the pressure off the ulcer or fractures and puts your weight on other areas of your foot and leg. Wearing this cast will let most ulcers and fractures heal in 6 to 8 weeks. A new cast is put on after 1 week. Another new cast is put on every week until the area is healed.  You will then wear a removable boot for several weeks and then into shoes that are appropriate for your condition.

Can I walk with the cast?

The cast is meant for you to walk on only to do the thing you need to do.  After the cast dries, do as little walking as you can, for several reasons:

  1. Your sore or fractures will heal faster if you put less pressure on it.
  2. The cast leg is now longer than your other leg which can cause pain in your hip or back
  3. If this happens you may need to see a shoemaker to have the opposite shoe temporarily raised up. 
  4. You’re less stable when you’re wearing a cast. Your chances of falling and hurting yourself are increased. The less you walk, the less likely you are to fall. Be very careful on slippery or uneven ground. Use a cane for added stability even if you usually don’t use a cane. Use a walker if you were already unsteady before the cast. Wear the special “cast boot” at all times, except in bed, to limit the chances of slipping.

Can I get my cast wet?

No. Even though the cast is fiberglass, it is not waterproof. You won’t be able to take regular baths because you have to keep the cast dry. Take sponge baths instead. Try not to go outside when it’s wet or raining. If you must go outside when it’s wet, wrap your cast in a plastic bag. Don’t shovel snow or walk in the rain.

When should I call Dr. Giacalone?

Call the office right away if any of the things listed below happens or you feel funny in the cast or have any questions.  Remember that you don’t have good pain sensation (ability to feel pain) in your foot and leg, so you might not be able to feel something going wrong. You must check your cast (or have someone else check it) every day. Watch out for these things and call Dr, Giacalone if you notice any of them;

  1. Loosening of the cast. The cast should fit your leg quite snug. If it becomes loose, it could rub your leg or foot and cause a new sore. A space of more than 1/4 inch between your cast and your leg is too much.
  2. Dents, cracks and other damage to the cast. A dent can apply dangerous levels of pressure to your leg, but you might not feel the pressure.
  3. A smell coming from the cast. This could be a sign of infection that started after the cast was put on.
  4. Signs of a fever (temperature of 100 or more) or a sudden, unexplained increase in your blood sugar levels.
  5. You are having a lot of pain in your back or hip           
  6. You get the cast wet.
  7. You are having problems with your balance.

Is there anything else I should know?

A few other tips may help you. You may have some itching under the cast. Don’t slide anything down the cast to scratch the itch, because you could very easily damage the skin underneath. You might try gently rubbing the same area of the other foot. Sometimes that helps.

When you’re sitting down, put your leg up on a chair or pillow whenever possible.

While you’re sleeping, you might kick or rub your other leg with the cast. This could cause some skin damage. It is a good idea to put a thick, soft knee-high sock over the other leg before you go to bed, or put a pillow between your legs. Also putting the cast leg in a pillowcase will help. 

If you think you have a problem, or if you would like more information on how diabetes affects your feet, call Dr. Giacalone.

Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders.  Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.