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(R) 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 vs. 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. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.