Short Leg Cast

Other Names

Illustration of the short leg cast

The short leg cast final product

The short leg walking cast

• Short Leg Cast
• Short Leg Walking Casts
• Short leg cast with toe plate extension
• Below Knee Walking Cast

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Background

• This page refers to the short leg cast
  • This begins 1-2 cm below the fibular head and extends distally to the proximal metatarsal heads
• Toe Plate Extension
  • Can be added for distal metatarsal, phalangeal fractures

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Indications

• Foot Fractures
• Ankle Fractures
• Walking Cast is appropriate for
  • Nondisplaced Fibular Shaft Fractures and Distal Fibular Fractures
  • Nondisplaced Metatarsal Fractures
• Toe plate extension is appropriate for
  • Some distal metatarsal fractures
  • Most Phalanx Fractures of the Foot

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Contraindications

• Most acute fractures
• Open fractures
• Injuries with neurovascular compromise
• Fractures with active swelling

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Procedure

Equipment

• See: Casting materials

Technique

• Patient positioning
  • Patient should be positioned so that the proceduralist has access to the affected leg
  • Most commonly the patient is seated on a treatment table with the leg hanging
  • Alternatively, the patient can lay prone with the knee flexed
  • The ankle should be immobilized in a neutral position at 90°
• Stockinette
  • Should extend about 5-10 cm proximal to fibular head and and additional 5-10 cm distal to the metatarsal heads
• Cast padding
  • Apply several layers of cast padding starting distal to proximal
  • Overlap about half the width of the padding avoiding protrusions, lumps and wrinkling
  • Apply extra padding over the calcaneus, fibular head (if covered), and both malleoli
• Cast material
  • After immersing in water, apply the plaster (4-6 layers) or fiberglass (2-4 layers)
  • Each layer should overlap by about half the width
  • Roll the stockinette and cast padding over the rough edges of the cast material
  • Apply one additional layer over the stockinette and casting padding
• Confirm neurovascular status
• Maintain the ankle in a neutral position until the cast material hardens

Toe Plate Extension

• Casting technique is essentially the same
• Extend the casting material beyond the distal toes on the plantar surface
  • This prohibits plantarflexion and limits dorsiflexion

Pearls and Pitfalls

• Weight bearing recommendations are made by the type, stability of the injury

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Aftercare

• Typically non-weight bearing until re-evaluated
• Advise patient to keep cast or splint clean and dry
• Do not insert objects into splint/ cast
• Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
• Seek further care if unable to control pain at home

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Complications

• Acute Compartment syndrome
  • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
• Plaster burn/ thermal injury
• Pressure sores
• Nerve palsy
• Vascular compromise
• Splint dermatitis
• Permanent joint stiffness
• Skin infection
  • Cellulitis from underlying wound, pressure ulcers

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See Also

• Casting Main
• Procedures Main

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