Overview

* This topic is in development and will be expanded soon. In the meantime, see topic "Offloading Devices" and "How to Select Offloading Devices".

• Knee-high non-removable device: total contact cast (TCC)
• • TCC should be considered for:
  • Severe foot and ankle deformities where fit into a controlled ankle movement (CAM) boot is questionable or impossible (i.e. Charcot deformity of the midfoot and ankle)
  • Treatment of ulcers associated with instability, such as fractures or Charcot foot. If leg swelling is present however, TCC is contraindicated, because as the edema subsides, the cast will become loose and cause iatrogenic ulceration.
  • If prescribing TCC for patients that need to climb stairs in their home, a physical therapy consult is appropriate to evaluate and improve gait and balance.
  • TCC are considered the gold standard for offloading non-complex DFUs, however they remain vastly underutilized in practice.[1][2] Barriers to a more widespread use of non-removable knee-high devices include the need for specialized cast technicians who can apply TCCs, the relatively longer duration of the procedure to apply a TCC, and issues with Medicare reimbursement. See section 'Coding, Coverage and Reimbursement' in topic "Offloading Devices".