Background: Although offloading foot ulcers with a total contact cast (TCC) remains the cornerstone of managing these wounds, the TCC is underutilized. Patient intolerance and potential iatrogenic complications due to TCCs' general lack of customizability and the inability to address flexible biomechanical deformities that are not in the sagittal plane may be one of the reasons patients with foot ulcers do not receive this crucial component of care.
Purpose: To describe the use of a novel approach to the standard TCC technique that uses strategic padding to potentially increase patient compliance and comfort while decreasing the likelihood of iatrogenic ulceration, as well as to correct flexible frontal plane biomechanical deformities with casting tape that is pulled medial to lateral, or lateral to medial, to bring the plantar surface of the foot to neutral position.