The present invention relates to orthopedic casts. In particular, some implementations relate to one or more components of a total contact cast system that can be used in the treatment of an appendage, such as a leg or foot. While the cast system can comprise any suitable component, in some cases, it includes a clam-shell cast, a foot support defining an offloading hole, a cast underlayment (such as a compression sock, a padding sock, and/or additional padding), and/or a footplate. In some implementations, the described cast system is configured to support a patients foot and leg, while offloading weight from a sore, ulcer, or other wound on the patients foot. Other implementations are also described.
