Unfortunately, if left untreated, diabetic foot wounds can become serious, placing you at risk for amputation and other life-threatening conditions. Fortunately, proper treatment along with early aggressive and effective management of the wound is the safest route to preventing complications BEFORE they occur!
Total contact casting is a method used to treat diabetic foot ulcers by fitting a non-removable cast around the affected leg. The whole cast is in contact with the foot and part of the leg, hence the name. The cast is usually made of fiberglass or plaster and is designed to protect the ulcer and allow wound healing. Total contact casting relieves pressure on the affected foot, which enhances healing by taking pressure off the ulcer and the other areas of the foot most prone to injury.
The “total contact cast” is a casting technique that is used to heal diabetic foot ulcers and to protect the foot during Charcot fracture dislocations. The cast is used to offload weight from the wound by catching some weight in the funnel of the lower calf and distributing the rest along the entire sole of the foot. It also helps in eliminating sheer and friction. It is applied in such a way to intimately contact the exact contour of the lower leg and foot; hence, the designation “total contact cast”. Most experts agree total contact casting is the gold standard in off-loading.
Reducing pressure on the wound by off-loading weight has proven to be very effective in diabetic foot ulcer treatment. Off-loading means reducing pressure or weight bearing on the foot ulcer. Many studies have shown that almost 90% of wounds heal in 5 to 6 weeks with Total Contact Casting (TCC), with healing rates and times varied.
The application and removal of TCC should be supervised by a physician or a licensed health care provider You should not use TCC if the vascular status is not adequate for healing, the wound is infected, or the wound involves deeper structures (tendon, joint, or exposed bone). Infection must be ruled out before being treated with TCC. Inappropriate use or removal of the total contact cast could result in serious injury.
You should contact your doctor immediately if any of the following occur while wearing a total contact cast:
• If the cast is “loose” or “rubbing” or “pistoning”
• If the cast is causing pain
• If the patient develops fever, chills, nausea, or vomiting
• If the cast gets wet
Pricing and Suppliers
Is it covered by Medicare Part B?
Medicare covers the application of total contact casts for persons with diabetic foot ulcers, along with the actual total contact cast
How can I purchase this product?
For Medicare to cover this product, it needs to be ordered and applied by your clinician. A patient cannot purchase it directly from a Durable Medical Equipment (DME) store and receive reimbursement from Medicare for it. However, this product is also available for purchase on an out-of-pocket basis (with no reimbursement from Medicare).
The table below shows highest and lowest Medicare pricing across the country
|Description||Medicare DME co-payment Min / Max
|Cast sup shrt leg, fiberglass||
$7.21 / $8.48
If your insurance does not cover this product, you can purchase it directly from any store. A list of online stores and prices is provided below for your convenience. For updated prices, find it on the internet at https://woundreference.com/app/product?id=739
* Indicates whether store accepts Medicare or commercial insurance, but may not apply to this specific product. See coding, coverage and reimubursement for more information.
The information on this handout is for your convenience and educational purposes only. All product claims and specifications are those of the product suppliers. It does not constitute medical advice or a guarantee for reimbursement. Prices may have changed and suppliers may not have product in stock. Please confirm accuracy and appropriateness of information with insurance carrier and product supplier. Clinician and WoundReference assume no liability for inaccuracies or misstatements about products and insurance coverage.