Procedures for Soft Casting of the Ankle

Procedures for Soft Casting of the
Ankle
Heather Blackburn, PT, MPT, CBIS
Molly Thomas, PT, DPT, ATP
Casting Procedure
• The casting techniques outlined in this
presentation are based on local expert
consensus. Reviews of the literature reveal
no clear agreement on specific casting
procedures.
• Techniques may vary slightly based on
clinician experience, training, and specific
patient population.
Casting Procedure
• Use a second trained person, such as rehab
technician, to assist with either positioning limb or
wrapping cast material as needed
• Complete serial casting evaluation and
measurements prior to applying cast
• If unilateral procedure, confirm appropriate limb to
be casted
Procedure for
Fabrication of Soft Cast
Serial Casts for Ankle
Materials for Soft Cast
Stockinette
3M Soft Cast
Material – 2”, 3”
Coban
Webril –
2”, 3”, 4”
Water
Bucket
Towels
Gloves
Foam Padding
– Temper foam
Additional Materials for Reinforced
Soft Cast
Buffer Strip
Durapore or
Micropore Tape
3M Fiberglass
Material – 2”, 3”
Hook Blade
Applying Stockinette
• Apply one layer of
stockinette
• Most close fitting size
without restricting
circulation
• Length should be 2-3”
above fibular head and 2-3”
beyond longest toe
• Smooth wrinkles
Positioning patient
• Position patient in prone
with knee flexed at 90
degrees (preferred) or
supine (if unable to be
positioned in prone)
• Position foot into
dorsiflexion while either
assistant or therapist
wraps materials
Applying Stretch Into Dorsiflexion
• When applying stretch:
• Apply submaximal stretch
• Try to position ankle in
between R1 and R2
measurements if patient has
spasticity
• Use palm, rather than finger
pressure, which could create
pressure point on cast
• Consider range of motion
goals
Applying Webril
• Wrap foot and leg with
webril
• 2”, 3”, and 4” options,
depending on leg size
• Start approximately 2cm
below fibular head
• Overlap by 1/3 – 1/2
width of roll
• Pull snug to prevent
wrinkles
• Repeat for 3 layers
• Extend webril about 1/2”
beyond longest toe
Placement of Pads
• Place temper foam pads over:
–
–
–
–
–
Calcaneus and heelcord
Maleolli
Dorsum of foot
Anterior, distal tibia
Other bony prominences
Applying Soft-Cast Cast Material
• Don gloves
• Choose soft cast material (2”
or 3” widths), depending on
size of leg
• Wet soft cast roll in cool water
for 3-5 seconds and squeeze
off excess water
• Apply soft cast while pulling
cast material tight – soft cast
expands with drying
• Continue to stretch into optimal
dorsiflexed position
Applying Soft-Cast Cast Material
• When laying down overlap by 1/3 – 1/2 width
of roll
• Avoid wrinkles, folds, creases – particularly
with weight bearing areas
• Extend cast material about 1/2” beyond
longest toe
Applying Soft-Cast Cast Material
• Fold outside layer of stockinette back and
cover with soft cast at top and bottom of cast
• Stretch cast at proximal tibia and at toes to
avoid circulation complications
• Allow to dry approximately 20-30 minutes
before weight bearing
Reinforcing Soft Cast
• Tape buffer strip to
anterior of knee
• Add second layer of
stockinette over soft
cast layer/buffer
strip
Reinforcing Soft Cast (continued)
• Apply fiberglass layer to
¾ of the leg
• Wet fiberglass roll for 35 seconds and squeeze
off excess water
• Apply fiberglass without
applying resistance –
fiberglass will shrink
when drying
Reinforcing Soft Cast (continued)
• Use hook blade, scissors, or cast saw to cut
fiberglass down buffer strip. Cut stockinette layer
along strip, and then remove strip
Applying Additional Soft Cast
• Follow with second
and third layers of
Soft Cast material
over fiberglass layer
for additional
reinforcement of cast
Wrapping with Coban
•
•
Finish serial cast by
applying colorful Coban
layer over final layer of
soft cast material
Fit casted extremity
with appropriate cast
shoe if patient performs
any weight bearing
Removal of Soft Cast
•
If used, peel off outer,
colored Coban layer of
casting material.
•
Find edge of Soft Cast
casting tape and
unravel.
–
This will feel like a stiff
ace wrap.
Removal of Soft Cast (continued)
• If a fiberglass layer has
been used: grip both sides
of cut edge with thumbs and
open up so that child can
remove foot completely from
cast layer.
• Continue to unravel casting
material down to the
padding layer and then
remove padding and
stockinette sock completely.
Following Soft Cast Removal
• Thoroughly wash foot and leg with warm
soap and water.
• The leg may feel very itchy following cast
removal.
– Discourage the child from scratching skin after
cast removal (to protect skin integrity).
– This sensation should be relieved after washing
with soap and water.
– Apply lotion to hydrate skin.