SHORT LEG CAST.-In applying a short leg cast, seat the patient on a table with both legs over the side, flexed at the knee. Instruct the patient to hold the affected leg, with the ankle in a neutral position (90 E ). Make sure that the foot is not rotated medially or laterally. Beginning at the toes, apply webril (figs. 2-3A, 2-3B, and 2-3C) in the same manner as for the short arm cast, ensuring that there are no lumps or

Figure 2-2.-Applying a short arm cast.

wrinkles. Apply the plaster beginning at the toes (fig. 2-3E), using the same technique of tucks and folds and smoothing as for the short arm cast. Before applying the last layer, expose the toes and fold back the webril. As the final step, apply a footplate to the plantar surface of the cast, using a generous thickness of plaster splints secured with one or two rolls of plaster (fig. 2-3F). This area provides support to the cast and a weight-bearing surface when used with a walking boot.

Whenever a cast is applied, you must give the patient written and verbal instruction for cast care and circulation checks (i.e., numbness, cyanosis, tingling of extremities). Instruct the patient to return immediately should any of these conditions occur.

When a leg cast is applied, the patient must also receive instructions in the proper use of crutches. The cast will take 24 to 48 hours to completely dry, and it must be treated gently during this time. Since plaster is water-soluble, the cast must be protected with a waterproof covering when bathing or during wet weather. Nothing must be inserted down the cast (e.g., coat hangers) since this action can cause bunching of the padding and result in pressure sores. If swelling occurs, the cast may be split and wrapped with an elastic wrap to alleviate pressure.