A guide to patients with a plaster cast

Why is a plaster cast required?

You have been placed in a below the knee cast to prevent you from injuring the site of the operation. It is very important that you comply with the advice that has been given to you about whether you can bear weight through the cast.

What is the difference between a back slab and a full cast?

A back slab is a slab of plaster that does not completely encircle the limb and is used following your surgery to allow for swelling. This type of plaster cast is only temporary and is usually replaced by a full cast two weeks after your surgery.

A full cast encircles the limb and is generally lighter. However, it only allows for a minimal amount of swelling.

What should I look out for?

While in the cast you may experience a number of changes, these can include:

New or increasing calf pain or shortness of breath

These symptoms are rare but if you experience them you should attend the nearest A&E department immediately as these symptoms may be a sign of a blood clot developing.

Colour and swelling

Slight duskiness or reddening of the toes is not uncommon when your leg is in a downward position, but the colour should return to normal when the leg is raised.

Swelling of your foot and toes will also occur and may be painful if the leg is down. This should also be reduced by resting and raising the leg to hip level.

If there is no reduction in the amount of swelling, pain or colour of the toes after the cast has been raised for about an hour, you should contact the Podiatric Surgery Department or A&E if out of hours.

Sensation

Mild pins and needles may develop when your leg is down. This sensation should subside when the leg is raised. If pins and needles remain the cast may be too tight and need to be re-applied.

The plaster cast has become too loose, cracked or soft

You should be able to move your toes in the cast, unless your toe joints have been fused together.

Under normal circumstances you should not be able to move the cast up, down or around your limb. It should feel comfortable. It should not be cracked at any point nor should it feel soft. If you notice any of these things contact the Podiatric Surgery Department.

Pain

When you have completed your course of painkillers any continued pain or new pain, at a later date, or painful rubbing in any area, should be reported to the Podiatric Surgery Department.

Smell

Your cast should not smell. If you notice a bad odour arising from the cast or your foot you need to contact the Podiatric Surgery Department.

Discolouration

You should not notice any discolouration or staining of your cast. If this is the case you need to contact us.

Itchiness

This is an unfortunate consequence of a cast. Never use anything to scratch under the cast - the slightest scratch could develop into a serious infection.

Modifications

Do not attempt to modify your cast in any way. Writing or drawing on the cast is allowed.

Never trim or cut down the length of the plaster cast yourself, or attempt to tuck in extra padding

Bathing

Do not get the cast wet. If the cast becomes wet it loses its strength and will need to be replaced. Cast covers can be obtained by phoning 01243 573 417 or online at www.limboproducts.co.uk

Can I drive?

You are not allowed to drive with any type of plaster cast.

Exercises while in your cast

• Fully bend and straighten your knee a number of times
• Move your toes up and down (this should not be carried out if you have had your big toe joint fused)
• Tighten and relax your calf muscle a number of times.

These exercises should be done every hour.

 What to expect when your plaster cast is removed

• You will probably experience slight discomfort and stiffness for a period of time.
• Your limb may feel weak due to a loss of muscle tone (this will return to its normal strength with time).
• Swelling of your foot is normal for some time after removal of the cast.
• A walking aid may be required for one to two weeks following removal.

Exercises after your cast has been removed

• Making the letters of the alphabet with your ankle
• Moving your ankle as if you were pressing down on an accelerator pedal.

These exercises should be done on a regular basis. The more exercises you do the faster the improvement.

Please contact the Podiatric Surgery Department if there are issues Monday to Friday during our opening hours. If you have a problem with your cast over the weekend or out of hours, you will need to visit your local accident and emergency department at the William Harvey Hospital (Ashford), Queen Elizabeth the Queen Mother Hospital (Margate), Maidstone Hospital or Pembury Hospital.

If you are unsure what to do or where to go in a non-emergency situation, phone 111. This is a free NHS helpline, open 24 hours a day.