Revisiting the total contact cast: maximizing off-loading by wound isolation.

A lthough the benefits of total contact casting for healing plantar neuropathic ulcers are consis tent throughout a large body of available literature, the method of cast application varies (1–17). Cast structure at the ulcer site provides one major variance, i.e., should the cast create total contact with the entire plantar surface of the foot or should the wound be isolated? This article aims to resolve this issue by examining the differences in plantar pressure at the wound site between total contact casting using full contact with the plantar aspect of the foot and wound isolation.