procedures for soft casting of the ankle · casting procedure •the casting techniques outlined in...
TRANSCRIPT
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.