Lavery et al. (2014) showed that TCC had a wound closure rate of 88.9%, compared to 50% for healing sandal and 40% for shear-reducing walking boot. They also showed that median time to healing for TCC was 5.4 weeks, compared to 8.9 weeks for a healing sandal and 6.7 weeks for sheer reducing walking boot. Armstrong et al. (2001) determined that TCC had a healing rate of 88.9%, compared to 65% for a removable cast walker and 58.3% for a half-shoe, and time to healing was least for TCC at 4.8 weeks, compared to 7.2 weeks for the removable cast walker and 8.7 weeks for the half-shoe. This data was reiterated by Lavery almost 14 years later in a newer study (Figure 3). There are four options currently available for total contact casting. The newer systems on the market today. Dermasciences TCC-EZ helps overcome the 'application' barrier (not the price/reimbursement barrier) to Utilizing a Proven Gold Standard Treatment. TCC-EZ offers a one-piece, roll-on, woven design that simplifies the application process when compared to a traditional total contact cast. The result of this technology is a total contact cast that can be applied in under 10 minutes while providing greater patient comfort  Another new system, TrueKast has a built in saw for ease in removal. This can prevent forced compliance from the patient and is also risky. Many experienced physicians are concerned putting a saw blade in-between a patient's skin and a hardened layer of fiberglass. Many patients with DFU's have peripheral neuropathy and poses a serious potential hazard. BSN Cutimed is a traditional fiberglass total contact cast system utilizing top of the line BSN cast tape. A doctor favorite in traditional TCC. One size fits all. M-Medical provides a traditional fiberglass total contact cast system with patented padding protection preventing iatrogenic lesions. One size fits all. Several options available to make utilizing TCC easier. Total contact casting is contraindicated in the presence of untreated infection or osteomyelitis and in patients with severe peripheral arterial disease. It should be used with caution in deep or heavily draining wounds and in ataxic, blind or severely obese patients. Patient compliance is also necessary to minimize complications. Patients may require assistance with activities of daily living, such as bathing and sleeping.