Community clinics cut diabetic foot ulcer healing time with total contact casting
A Western Canadian health authority’s wound program put total contact casting into three community clinics and published the results in Hospital News on September 30, 2026. Authors Christina E. Hagne, Jeff Wang, and Nicholas Salterio describe TCC as the guideline-backed way to offload a neuropathic plantar diabetic foot ulcer so the wound can close.
Before the program, diabetic foot ulcers in that system took an average of 162 days to heal, with a 46 percent healing rate. About 12,000 clients a year receive community wound care there. Diabetic foot ulcers were about one-third of complex chronic wounds and were tied to more than 100 amputations a year. The authority had also seen a 16 percent rise in these ulcers while healing rates fell.
The clinics did not just buy supplies. They named clinical champions, funded about $10,000 per site for equipment and initial stock, wrote protocols and patient-selection rules, and trained wound, ostomy, and continence nurses. Most nurses needed about two weeks and eight cast changes before they applied and removed casts on their own. First casts went on early in the week, with a check in 48 to 72 hours, then changes every five to seven days.
Across the three sites, 71 percent of TCC-treated wounds healed, versus 38 percent with standard care. Wounds that eventually healed had already been treated for an average of 188 days before casting started. Once TCC began, average time to healing was 36 days. Standard-care patients averaged 20 nursing assessments; TCC patients averaged 11. One person who had been seen twice a week for about 15 months, more than 240 visits, had foot pain resolve within two days of casting, and the wound then healed. Staff also found that healing was not the end of care: some ulcers returned after the cast came off, so the program pushed a handoff to removable boots, custom insoles, and proper shoes.
Hagne, Wang, and Salterio put it this way: total contact casting works by “distributing pressure away from the wound and limiting repetitive trauma during walking.” They also note that moving TCC into everyday clinics “requires leadership, training, standardized protocols, appropriate patient selection and ongoing measurement.”
Full article: A better way to heal diabetic foot ulcers, Hospital News, September 30, 2026.