Page 255 - Orthopedic Casts and Splints2

Performance Steps

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Foot portion of TCC

NOTE: The TCC is used exclusively for diabetic patients with ulcers of the foot/leg that are not healing
in a timely manner.

NOTE: Total Contact Cast (TCC ) is applied from the tips of the toes to 3 inches distal to the popliteal
space, with the ankle at a 90 degree angle. The cast allows complete knee flexion and extension,
restricts phalanges, foot and ankle movement (Refer to Figure 3-x).

CAUTION: During cast application a chemical response(exothermic reaction) will occur between the
water(H2O) and the plaster ( gypsum). This is a safe and common occurrence. The cast will initially
become warm and cool down within 2-5 minutes. However, if it doesn't cool down or there is an
increase of heat intensity during the cast application, the cast may need to be removed.
4. Inspect patient's upper extremities.
a. Place examination gloves on hands.
CAUTION: Always practice Body Substance Isolation (BSI) prior to applying traction, splints or casts
to patients.
b. Remove patient's shoes and socks from both feet. Roll pant leg above the knee.
NOTE: If patient is unable to get pant leg easily above knee, provide patient with paper shorts or
hospital scrubs. If unavailable, cut the pants at the seam.
c. Place patient in supine position on the examination bed.
d. Check patient's injured leg for any skin conditions ( e. g. cuts, abrasions, lacerations and skin
rashes ).
e. Examine both legs for jewelry and remove if found.
NOTE: All jewelry on both ankles must be removed. Give jewelry to family member or secure with
patient's belongings in NCOIC office.
5. Check patient's capillary refill.
a. Squeeze patient's toes and nail beds will turn white .
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