wrinkles. Apply the plaster beginning at the toes (fig.2–3E), using the same technique of tucks and folds andsmoothing as for the short arm cast. Before applyingthe last layer, expose the toes and fold back the webril.As the final step, apply a footplate to the plantarsurface of the cast, using a generous thickness ofplaster splints secured with one or two rolls of plaster(fig. 2–3F). This area provides support to the cast and aweight-bearing surface when used with a walkingboot.Whenever a cast is applied, you must give thepatient written and verbal instruction for cast care andcirculation checks (i.e., numbness, cyanosis, tinglingof extremities). Instruct the patient to returnimmediately should any of these conditions occur.When a leg cast is applied, the patient must also receiveinstructions in the proper use of crutches. The cast willtake 24 to 48 hours to completely dry, and it must betreated gently during this time. Since plaster iswater-soluble, the cast must be protected with awaterproof covering when bathing or during wetweather. Nothing must be inserted down the cast (e.g.,coat hangers) since this action can cause bunching ofthe padding and result in pressure sores. If swellingoccurs, the cast may be split and wrapped with anelastic wrap to alleviate pressure.Cast RemovalA cast can be removed in two ways: by soaking inwarm vinegar-water solution until it dissolves, or by2-22Figure 2–3.—Applying a short leg cast.
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