Initial steps may be done with the patient in a prone position.

1. Preparation of the foot:

1. A. If an ulcer is present: debride ulcer as necessary. Apply dressing to ulcer. This is held in place with paper tape. No circumferential dressing is applied, as this would pose a risk of irritation to the skin or possible vascular compromise.
   

2. B. If the TCC is being applied for persons with Charcot and no ulcer, then no special dressing is required.
   

3. C. Be sure that all toenails are debrided.
   

4. D. Ensure that skin is well hydrated, using emollient of choice.
   

5. E. Cotton or lamb's wool may be placed between the toes to reduce maceration.

2. 2.Cotton stockinette is applied to the foot and leg.
   

3. A. Stockinette should be snug and form fitting.
   

4. B. Fold stocking over the toes dorsally and tape it in place.
   

5. C. Make a cut in the stockinette at anterior ankle and tape in place.

3. A Removable Cast Walker (Active Offloading Walker, Aircast Diabetic Walker, Bledsoe Boot) is then applied to the foot.

4. The device is then wrapped with a single layer of cohesive bandage or plaster of Paris.