Casting

Fig 1. Application of a total cast.

Before applying a cast you want to clean the site if any open wound or contamination is seen. Make the patient comfortable by giving him an ice pack, you may need to get anesthesia to lessen the pain. First, apply a stockinette over the foot and leg, make sure its long because you will eventually fold it to appropriate length, seen in Fig 1A. Second, add soft padding to protect the skin such as web roll. You want to add extra layers of padding at the MTPJs, heel, and bony ankle prominence, seen in Fig 1B. Third, find the appropriate plaster or fiberglass and have the appropriate length that you will use. Fourth, dip the plaster or fiberglass into lukewarm water. Fifth, begin wrapping the foot and leg, each layer will overlap about half to produce a double layer. Let it sit for 5-10 minutes until its harden. At this time make sure the foot is at a 90 degree angle. In addition you want to stay about 2cm from the fibular head to avoid injury the nerve, as seen in Fig 1C. Check for any missed/uncovered areas or any restriction of blood flow if too tight.

Splint

Fig 2. Application of a posterior splint.
Fig 3. Different types of splints for the foot and ankle.

Placing a splint is similar to a cast, but the plaster or fiberglass doesn’t cover the whole foot. First, apply a stockinette, seen in Fig 2A. Second, add soft padding to protect the, seen in Fig 2B. Third, find the appropriate plaster or fiberglass to cover the posterior leg and dip the plaster or fiberglass into lukewarm water. Let it sit for 5-10 minutes until its harden. At this time make sure the foot is at a 90 degree angle. Stay about 2 cm from the fibular head to avoid injury the nerve, as seen in Fig 2C. There are a couple of variations besides a Posterior Ankle Splint, such as a Half Splint or Sugar-Tong Splint, as seen in Fig 3.