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TCC-EZ® Patient Information

Discuss with your doctor if Total Contact Casting is right for you!

What is a Total Contact Cast?

A Total Contact Cast (TCC) is a cast used to off-load foot wounds by minimizing pressure and friction at the wound site. A TCC is in “total contact” with the foot and lower leg to redistribute weight away from the wound. A TCC is also used in the initial treatment of the Charcot foot to control the movement of the foot and support its contours.

Why use a TCC-EZ®?

The TCC is considered the GOLD Standard for off-loading. 89% of patients with diabetic foot wounds off-loaded in a TCC heal in approximately 43 days (6 weeks)1. TCC–EZ® will enable the patient to maintain daily activities by allowing them to walk and continue their daily routine while being treated for their foot wound.

What will treatments be like?

The first cast change will take place 2-3 days after the first cast is applied. Afterwards, cast changes will take place from 1 to 2 times per week up to every other week as determined by your doctor. You will need to wear a cast for 1 to 2 additional weeks after your wound has healed to ensure your skin has returned to normal thickness.

Is patient compliance an issue when using TCC-EZ®?

The material used for the outer cast is a patented fiberglass resin that dries quickly to a light weight semi-rigid supportive shell that requires a cast saw for removal. A patient cannot remove the cast unless he has a cast saw. Even when going to the bathroom in the middle of the night the patient still has the benefit of being in the cast.

Can TCC-EZ® fit any shape of foot or leg?

TCC-EZ® incorporates a simple roll-on technique that provides a custom fit for each patient according to their individual anatomical shape.

Can TCC-EZ® be used for Charcot Foot?

TCC-EZ® offers a specialty designed insert to accommodate deformities.

Who applies TCC-EZ®?

TCC-EZ® is an off-loading system and is not an orthopedic cast. TCC-EZ® can be applied by a clinician who has been trained in the roll-on technique, which requires CERTIFIED FULL training.

How do I educate my staff on the available TCC® products and the importance of off-loading?

Derma Sciences provides extensive in-servicing education to customers through on site seminars and training programs. Online meetings with our staff of clinicians and field-based expert representatives support the clinicians in an ongoing approach. Educational materials can also be found on our website at Please contact your representative to arrange for an in-servicing meeting to take place within your facility.

How much time is required in applying TCC-EZ®?

Studies demonstrate with the TCC-EZ® system, the average time a patient spent in the application process was 8 minutes and a setting time of 8 minutes. The patient can leave the office within 20 – 25 minutes, during a routine cast change procedure. This is about ¼ the amount of time of traditional systems.

What is the typical inventory of kit units that I should expect to dispense per month?

Maintaining an inventory of at least 1 case (10 casting systems) of each TCC-EZ® size, 7.6cm and 10cm, and a range of three boot sizes, regular, large and extra large, will enable a practice to accommodate treatment needs as they arise.

1. Armstrong DG, et al. Off-loading the diabetic foot wound. Diabetes Care 24:1019-1022, 2001 2. Bloomgarden ZT: American Diabetes Association 60th Scientific Sessions, 2000. Diabetes Care 24:946-951, 2001. 3. Coleman W, Brand PW, Birke JA: The total contact cast, a therapy for plantar ulceration on insensitive feet. J Am Podiatr Med Assoc 74:548 –552, 1984. 4. Helm PA, Walker SC, Pulliam G: Total contact casting in diabetic patients with neuropathic foot ulcerations. Arch Phys Med Rehabil 65:691– 693, 1984. 5. Baker RE: Total contact casting. J Am Podiatr Med Assoc 85:172–176, 1995 6. Sinacore DR, Mueller MJ, Diamond JE: Diabetic plantar ulcers treated by total contact casting. Phys Ther 67:1543–1547,1987 7. Myerson M, Papa J, Eaton K, Wilson K: The total contact cast for management of neuropathic plantar ulceration of the foot. J Bone Joint Surg 74A:261–269, 1992 8. Walker SC, Helm PA, Pulliam G: Chronic diabetic neuropathic foot ulcerations and total contact casting: healing effectiveness and outcome probability (Abstract). Arch Phys Med Rehabil 66:574, 1985 9. Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VPD, Drury DA, Rose SJ: Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 12:384 –388, 1989 10. Liang PW, Cogley DI, Klenerman L: Neuropathic ulcers treated by total contact casts. J Bone Joint Surg 74B:133–136, 1991 11. Walker SC, Helm PA, Pulliam G: Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil 68:217–221, 1987 12. Armstrong DG, Lavery LA, Bushman TR: Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts. J Rehabil Res Dev 35: 1–5, 1998 13. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL: Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations: a comparison of treatments. Diabetes Care 19:818–821, 1996 14. Lavery LA, Armstrong DG, Walker SC: Healing rates of diabetic foot ulcers associated with midfoot fracture due to Charcot’s arthropathy. Diabet Med 14:46–49, 1997 15. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL: Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot. Arch Phys Med Rehabil 78:1268–1271, 1997. 16. Fife CE; Carter MJ, Walker D: Why is it so hard to do the right thing in wound care? Wound Rep Reg 18: 154–158, 2010. 17. Jensen J, Jaakola E, Gillin B, et al: TCC-EZ –Total Contact Casting System Overcoming the Barriers to Utilizing a Proven Gold Standard Treatment. DF Con. 2008. 18. Snyder RJ, et al. The Management of Diabetic Foot Ulcers through Optimal Off-loading. Building Consensus Guidelines and Practical Recommendations to Improve Outcomes. Journal of the American Podiatric Medical Association. Vol 104. No. 6. Nov/Dec 2014. 19. Lavery AL, et al. Randomised clinical trial to compare total contact casts, healing sandals and a shear-reducing removable boot to heal diabetic foot ulcers. Int Wound J 2014. 20. Fife CE, et al. Diabetic foot ulcer off-loading: The gap between evidence and practice. Data from the US Wound Registry. Adv Skin Wound Care. 2014 Jul;27(7):310-6. 21. Piagessi, et al., Semiquantitative Analysis of the Histopathological Features of the Neuropathic Foot Ulcer, Diabetes Care. 2003 Nov;26(11):3123-8. 22. Bohn G. Cost, Effectiveness and Implementation of an Easy to Apply Total Contact Casting System for Diabetic Grade 2 Neuropathic Foot Ulcers in a Multi Physician Clinic, Clinical Symposium on Advances in Skin and Wound Care, October 2009, San Antonio, USA, Poster. 23. Snyder RJ, et al. The Management of Diabetic Foot Ulcers through Optimal Off-loading. Building Consensus Guidelines and Practical Recommendations to Improve Outcomes. Journal of the American Podiatric Medical Association. Vol 104. No. 6. Nov/Dec 2014