From the Guidelines
A healing cast is a total contact cast, which is a well-moulded, minimally padded, knee-high non-removable fibreglass or plaster cast that maintains total contact with the entire plantar surface and lower leg 1.
Key Characteristics
- Non-removable: to ensure continuous offloading and immobilization of the foot and ankle
- Knee-high: to redistribute plantar pressure and ground reactive forces more proximally, serving to offload the inflamed foot
- Total contact: to maintain contact with the entire plantar surface and lower leg, providing pressure redistribution and preventing subsequent ulceration
Types of Healing Casts
- Total contact cast (TCC): made of plaster of Paris or fibreglass, in close contact with the entire foot and lower limb 1
- Windowed cast: same as a total contact cast but with a window cut out at the site of an ulcer to facilitate wound assessment and treatment in-between cast replacements 1
- Removable knee-high device: can be considered as a second or third choice, but may have lower adherence and potentially delayed healing 1
Indications
- Neuropathic plantar forefoot ulcers: without ischemia or uncontrolled infection in patients with diabetes 1
- Active Charcot neuro-osteoarthropathy: with intact skin, to immobilize and offload the foot and ankle 1
From the Research
Definition of a Healing Cast
A healing cast, also known as an orthopedic cast, is a type of medical device used to immobilize and support a broken or fractured bone, allowing it to heal properly.
Types of Casts
- Casts are circumferential immobilizers that provide superior immobilization but are less forgiving and have higher complication rates compared to splints 2.
- There are different types of casts, including traditional casts, waterproof casts, and 3D-printed casts 3, 4.
- Each type of cast has its own indications and application techniques, and the selection of a specific cast depends on the area of the body being treated and the acuity and stability of the injury 2.
Purpose of a Healing Cast
- The primary purpose of a healing cast is to immobilize the affected area, allowing the bone to heal properly and reducing the risk of further injury 2, 3.
- Casts can also be used to manage pain, swelling, and other complications associated with fractures 5.
- The use of casts can be limited to the short term to minimize the risk of chronic pain, joint stiffness, muscle atrophy, and other complications 2.
History of Healing Casts
- The use of plaster of Paris (POP) casts as an immobilization tool to promote healing in complex fractures has a long history, with evidence suggesting that it may have originated from the Persian Empire 6.
- The exact origin of using POP in orthopedic casts is still unclear, but it is known that Antonius Mathysen extensively applied plaster cast during wars and reportedly saved thousands of lives 6.