Clinical audit of the use of total contact casting for treatment of plantar foot ulcerations: A podiatry/plaster room joint initiative

Mr Joshua Palaya1, Mr Scott  Grieve2, Mr Barry  Zeitzen2

1Podiatry South, Hobart, Australia, 2Plaster Clinic/Physiotherapy Service, Hobart, Australia

Evidence-based practice indicates that a Total Contact Cast (TCC) or a non-removable knee high device is the ‘gold standard’ for offloading neuropathic plantar foot ulcers and for the management of Charcot Neuroarthropathy. The Podiatry Service along with the Plaster Room (Physiotherapy Service) has responded to this evidence by commencing a joint TCC clinic in October 2016. Prior to this the ‘gold standard’ of care was not available to patients in Southern Tasmania with barriers to providing this care identified as; the lack of skill or suitably trained staff, inconvenience to the patient, cost of consumables and preference for other sub-optimal treatment modalities. Since October 2016 the interdisciplinary clinic has enabled better access and care for patients, maximised the utilisation of existing skill sets, reduced cost and use of sub-optimal treatment options.

Following ethics approval by the Tasmanian Health and Medical Human Research Ethics Committee an ongoing audit has been developed to evaluate our hypothesis that patients undergoing weekly total contact casting are expected to have a reduction in time to heal and remain healed for the long term with minimal iatrogenic complications. The 3 main outcome measures explored are:

  1. Reduction in time to heal: Measured by the length of time the ulcer has been present versus the length of time it takes to heal in a total contact cast measured in weeks.
  2. Remaining healed: Measured by the number of weeks the patient remains healed at the same site of initial ulceration following cessation of total contact casting.
  3. Iatrogenic complications from a total contact cast such as formation of a new ulcer, abrasions, blistering, infection, ulcer deterioration, falls and amputation will be recorded on an ongoing basis for each patient.

This poster will present the outcomes of this ongoing innovative collaboration.



Josh has a special interest in lower limb biomechanics and offloading of the high risk foot. He has developed this interest in his role as a Podiatrist in the THS but has also worked in rural/regional WA, Bangladesh and various locations in Southern Tasmania. During this time he has had good exposure to the complexities of managing the high risk foot in various settings and has applied this knowledge in leading the current collaboration with the plaster technicians to achieve better outcomes in this group of patients.

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