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1.
Prepare the foot
A. Debride toenails
B. Rehydrate skin with emollient
C. Place cotton between toes to absorb moisture.
D. Debride ulcer as necessary and apply light dressing.
(Ulcer must be wider at the surface than it is deep).
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2.
Apply sockinette to the leg.
A. Sockinette must be firm with no wrinkles.
B. Fold sockinette dorsally over the toes, and tape it
in place.
C. Make a cut in the sockinette at the ankle joint level
and seal it with tape.
Please
note that in the following photographs, the foot has been
placed in a more plantarflexed position than it should
be for this cast- the foot should be approximately at
a right angle to the leg.
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3.
Apply a 3-inch wide strip of 7mm adhesive felt to the
anterior aspect of the leg.
Bevel the edges of the felt well. The felt must extend
from the dorsum of the toes to
the tibial tuberosity.
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4.
Cut two circular pieces of felt large enough to cover
and protect both malleoli, then
tape in place. Bevel edges well.
A
piece of 4-inch foam is taped across the tips of the toes
from the dorsum to plantar
surface of the foot.
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5.
Apply a 4-inch roll of plaster of paris to the foot and
leg so that it extends from the
base of the toes to the proximal extent of the felt.
Care
must be taken to eliminate all
bulges and folds of plaster, especially on the bottom
of the foot.
Hold
the foot at 90
degrees to the leg. Be sure to only use the flat surfaces
of the hands and avoid using
fingertips.
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6.
Several layers of plaster of paris are applied to the
bottom of the foot so it is perpendicular to the long
axis of the leg. This create a rockerbottom sole aiding
propulsion during ambulation.
Alternatively,
a 4-inch piece of plywood may be
applied to the sole of the foot to create the rockerbottom.
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7.
Apply a 3-inch roll of fibreglass to the foot covering
the plaster of paris. Apply
evenly and avoid bumps and sharp edges.
A
rubber walking heel may be placed on the sole of the foot
just proximal to the
metatarsal heads (optional).
Complete
the rest of the cast with 3-inch roll of fibreglass, covering
the foam over the toes. One to two more rolls of material
are usually used at this point.
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8.
The patient is required to remain in the office for approximately
30 minutes to allow for drying and to be sure that the
fit is acceptable.
When
the cast is ready for changing a cast saw is used to remove
the cast. The cast should be cut along the anterior border
of the cast where there is felt padding protecting the
leg.
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