Total Contact Cast application | Introduction to Casting

1. Sockinette is applied to the lower third of the leg, extending 10cm beyond the toes.
2. Mark the lesion. Apply felt padding to remove pressure from the wound site.
3. Using 7mm semi-compressed felt cut a slab to cover the sole of the foot so that it extends up both sides of the foot and the heel. Use additional 5mm felt for valgus fillers or wedges if required. Cut a window in the felt if required.
4. Wrap a strip of 5mm x 7-10cm wide felt or sponge rubber around the ankle for malleolar protection and secure with micropore.
5. Hold the felt slab securely in place with two rolls of 10cm Softban. Evenly distributed over the whole area. Mark the lesion if necessary.
6. Apply one roll of 2 inch fiberglass from the toes to the ankle. Apply the remaining 3 inch roll from the ankle to the toes. Be sure to rub the fiberglass well to get a smooth finish. REMEMBER TO ALWAYS WEAR GLOVES.
7. It is important to get the patient weightbearing in a normal stance position to facilitate ambulation - it is best to stand on a piece of foam or similar to prevent sticking to the floor.  8. Once the cast is dry mark the lesion and cutting lines.
9. Using a plaster saw, bi-valve the cast on the dorsum and trim to the required height and length. Remove the bi-valve.
10. Cut the sockinette and turn the sockinette back over the ankle and toes and secure with 3 inch extension plaster.
11. Remove cast from the foot and seal the cut ends of the padding using 3 inch Extension plaster.
12. Apply a rubber sponge strip along the dorsum of the foot and ankle.
14. Apply a 3 layer slab of fiberglass on the sole of the foot to create a rockerbottom sole.
15. Wrap another roll of fiberglass around the foot from the toes to the ankle.
16. Mark the bi-valve on the dorsum of the foot and cut with a cast saw.
17. Cover the edges of the cut fiberglass with extension plaster so there is no sharp corners Refit the boot to the foot and hold firmly in place. A tongue pad of felt helps to add comfort and firmness.
18. Use a Post-Op walking shoe at all times when weightbearing. The cast can be removed and replaced as necessary for dressing, bathing and sleeping etc.