The prevalence of symptomatic in patients requiring total contact casting for neuropathic foot complications

The total contact cast (TCC) is considered the gold-standard treatment for plantar neuropathic ulceration and acute Charcot neuroarthropathy. There is little evidence on the risk of venous thromboembolism (VTE) associated with TCC treatment. It is widely accepted that routine VTE chemoprophylaxis is not required for neuropathic patients treated with a TCC. Aims: This study aimed to investigate the rate of symptomatic VTE in neuropathic patients with a TCC and to provide up-to-date information to guide future practice. Methods: A retrospective service evaluation was undertaken. The PASCOM-10 online database was utilised for data collection within a community-based podiatric surgery unit. Patients treated with a TCC or TCC with Bohler walker for plantar ulceration or Charcot neuroarthropathy between 2019 and 2021 were identified. Data were reviewed to ascertain if any evidence of symptomatic VTE had been recorded during casting. Results: A total of 53 casting episodes in 40 patients were included. All patients had a diagnosis of peripheral neuropathy. The mean length of time in a cast was 51 days (range 14–161 days). No episodes of total contact casting resulted in a symptomatic VTE. Conclusion: The use of TCC did not increase the prevalence of VTE in this patient cohort. Larger, prospective studies are warranted to further investigate VTE risk in neuropathic patients treated with a TCC and the theorised VTE protective mechanisms in this patient population.