Total contact casts: Pressure reduction at ulcer sites and the effect on the contralateral foot

Objective: To compare the effectiveness of total contact casts with a cast boot (TCCB), total contact casts with a cast heel (TCCH), and therapeutic XtraDepth® shoes (XDS) to reduce ulcer site pressures and to determine if total contact casts increase contralateral pressures. Design: Repeat measure design with 40 replications nested within each treatment for each patient. Methods: Peak contralateral foot pressures and ulcer site pressures under the 1st metatarsal (1MET; n = 10), 2nd to 5th metatarsals (2- 5MET; n = 10), and great toe (GT; n = 5) were compared using the Novel-Pedar system and three treatments: TCCB, TCCH, and XDS. Baseline pressures were established using canvas oxfords. Results: There was no difference in pressure reduction with TCCH rs. TCCB for 1MET or GT ulcers, but TCCH reduced pressure better for 2-5MET ulcers (p < .001). Contralateral pressures were not elevated in either TCC group. Conclusions: TCCH were superior to TCCB in reducing 2-5MET ulcer pressures and equivalent to TCCB for 1MET and GT ulcers. Contralateral pressures are not increased by TCC use.