Procedures for Soft Casting of the Ankle · Casting Procedure •The casting techniques outlined in...

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

Foam Padding

– Temper foam

Webril –

2”, 3”, 4”

Water

Bucket

3M Soft Cast

Material – 2”, 3”

Towels

Gloves

Coban

3M Fiberglass

Material – 2”, 3”

Hook Blade Durapore or

Micropore Tape

Buffer Strip

Additional Materials for Reinforced

Soft Cast

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

• 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 Stretch Into Dorsiflexion

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

• 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

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 3-

5 seconds and squeeze

off excess water

• Apply fiberglass without

applying resistance –

fiberglass will shrink

when drying

• Use hook blade, scissors, or cast saw to cut

fiberglass down buffer strip. Cut stockinette layer

along strip, and then remove strip

Reinforcing Soft Cast (continued)

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.