LOWER EXTREMITY CASTS

 

SHORT LEG CASTS

SHORT LEG WALKING CAST

Material:

3” or 4”  Stockinette

2  3” Rolls Webril

2  4” Rolls Webril

Cast Stand

Casting Gloves

Scissors


Indications:

Ankle Fractures and Sprains

Some Foot fractures/Sprains


Application:

Cut Stockinette from toes to apprx the patella, unroll stockinette up the leg.  Place foot on cast stand.  Ankle should be placed at apprx 90 degrees ankle in order to patient to walk comfortably.  Angles for short leg should be: ankle at 90 degrees, 2nd toe should be lined up with the patella.  Start with 3” roll webril around toes, wrap entire foot and include ankle using the first roll.  Use 4” Webril and continue from the ankle up the leg stopping apprx 3 fingerwidths from bottom portion of patella.  Make sure all bony prominences are padded adequately which include the lateral malleolus. Start with 3” roll of fiberglass and use same pattern as you did with webril.  After you finish with the first fiberglass roll, take cast scissors and cut top part of fiberglass off that is covering the toes, leaving the bottom portion of fiberglass intact underneath the metatarsal heads.  This is called a ‘toe plate’ and supports the bottom of foot when the patient walks with cast.   Taken second roll which should be 4” fiberglass continue following webril pattern from ankle up the leg stopping with 1/2 Webril margin under fiberglass.  Next flip the stockinette ends over onto the fiberglass and take your next roll 4” starting at top of cast and roll downward towards ankle. Finish that roll and take next 3” roll and continue from ankle to cover foot and reinforce any weak areas around ankle, heel or  bottom of foot.  


Molding:  Take the heel of your  hand and place into the arch of the foot to make a slight mold so the cast will conform to the shape of the foot.  Keep cast on cast stand until you feel fiberglass has set before removing leg from cast stand. Patient should be instructed to keep cast clean, dry, nothing inside the cast to scratch, no weight bearing for at least one hour. Patient should be given cast shoe to wear on the bottom for traction.


Non-weight bearing short leg cast:

Applied the same as a weight bearing cast. Ankle may not necessarily need to be placed at 90 degrees depending upon type of injury.  Use same amount of material. No cast shoe is given as patient should not be weight bearing and should be either on crutches or walker


Patellar Tendon Bearing (PTB) cast:

Modified short leg cast with top of cast having “wings” that encompass medial and lateral side of knee and back of cast is cut down in the back to allow flexion at the patellar crease. This is used as a transitional cast after patient has come out of a long leg cast for partially healed tibia or tib/fib fracture and patient may begin weight bearing in a cast that allows motion at the knee but prohibits rotational forces at the knee which may harm the fracture. The weight bearing forces are also changed because of the wings and cast covering distal 1/3 of the  patella which shifts the weight bearing forces from the shaft of the long bone to the proximal end of the tibia and the knee.


EQUINOUS CAST:

Same as a short leg with difference being foot is allowed to drop to an equinous position with ankle relaxed and foot/toe allowed to point towards the floor.  Primarily used in treatment for Achilles tendon rupture or post repair of Achilles tendon rupture.


LONG LEG CAST:

Primarily used for treatment of fractures of the tibia and/or fibula shafts, ankle fractures, ligament injuries.

Application:  The lower portion is the same as a short leg cast and that cast is extended up the leg to stop at the top of the thigh.  This cast may or may not be weight bearing depending upon injury.  Weight bearing casts may have the knee bent anywhere from 5 degrees to 30 degrees to allow ease of ambulation.  Non weight bearing long leg casts are usually applied with knee bent at 90 degrees so patient is unable to place foot on ground to place weight on the leg.


CYLINDER CAST:

Same as a long leg cast except there is no foot portion.  Cast stops above the ankle.   Used some times for patella fractures, tendon/ligament injuries