Spotlight on Casting | Tools for Casting

This article is second in a series about casting. Look for more on hand-holds and the casting process in future issues of Dafo Dynamics.

There may be as many casting styles as there are practitioners, and these styles each have their own methods and tool set. So this list isn’t comprehensive. It simply supports the casting process we advocate. You can order all of these items on the Casting Supplies order form.

Hand-hold The arrangement of your grip as you hold a foot in correction (or as close to it as you can get) is perhaps the most important tool you have. It should vary depending on the patient presentation. Here’s a description of a basic hand-hold for a fully-correctible foot. Face the patient and rest the foot on a raised level surface (like a bench) or the floor. To simulate weight-bearing, ask a helper to push down on the knee. First, establish a vertical hindfoot. Use one hand to establish vertical heel. Second, correct the forefoot alignment (while the heel remains corrected). Use your other hand for this. Third, adjust the ankle angle by sliding the whole foot (while held) forward or back. Keep in mind that you want to cast with as much correction toward “balanced” as possible. Casting tape We use fiberglass casting tape, specifically Royce Medical Techform® Ortho-Roll. It comes in 2- or 3-in. widths; we tend to prefer the 2-in. width, switching to the 3-in. for teens and adults. When you use it, you’ll need a bowl or plastic container as well, with enough volume to hold a roll of tape in room-temperature water. This tape sets up fast, so concentrate on your timing—both the amount of time to leave it in water and the amount of time you’ve got to wrap the foot. Don’t open the package of casting tape until you are ready to soak it: it can begin setting up just from moisture in the air.

Stockinette Stockinette is a tube of soft-knit cotton jersey that surrounds the patient’s leg as you cast. You’ll usually use two lengths of stockinette for each foot you cast: this allows for a little bit of extra growth room in the finished brace. The stockinette should generously extend past the toes and reach up to the knee. Smooth it over the contours of the patient’s leg. One piece will go on first before anything else. With the second length of stockinette over the first, slip the cutting buffer strip between the two layers.

Casting footplates If the patient’s foot is fully correctible, casting footplates are a real help to establishing good foot position in the cast and also defining plantar contours. Choose a size that is a fairly snug fit but not tight. Once you’ve put on one layer of stockinette, the footplate goes between that and the top stockinette layer, like the buffer strip. That way, when you cut the cast off, you retrieve your footplate. Our casting footplates nest for easy storage and transport. Buffer strip The yellow buffer strip, with a channel along its outside, provides safe “guard rails” for cutting the cast off. It runs along the dorsal side of the foot and lower leg, from the knee to the toes. Nitrile gloves The casting tape gets a little gooey as it sets up. Need we say more?

Hook-blade knife This tool, a utility knife with a special hooked-edge razor blade, is ideal for cutting the cast off safely and without the frightening noise of a cast saw. Generally you start near the top of the cast, gently pushing the knife into the channel of the buffer strip, and pull the blade down through the fiberglass toward the toes. Walking or wiggling the hook slowly and gently through the instep area, which often has the thickest coverage, can help get through the curve. DO NOT put your other hand below the knife as you cut down. Replacement blades are a little more than $1 each; change them every 20 or 30 casts for the smoothest, easiest, most controlled cut through the fiberglass. Once you’ve cut through the cast material, you’ll need to cut the stockinette edges that extend beyond the casting tape. For this you’ll switch to . . . Scissors Use any scissors with a blunt tip (such as bandage scissors) to cut through the top and bottom pieces of stockinette that extend beyond the cast. Be sure to cut within the buffer strip channel. Electrical tape Standard black electrical tape works fine for re-connecting the edges of the cast once you’ve cut it off. This way, the cast cures in its true shape. Sharpie® For clarity, be sure to write the patient’s name on both casts. A Sharpie does the trick.

Flipper The flipper, showing strap, trim and padding choices, is a good tool for patient and parent to decide what they’d like. Then you’ll be ready to choose these and other options on the...

Order form Fill out the order form right after casting, before you forget the many choices involved.

Helper Enlisting a helper to glove up and hold the patient’s foot and leg while you cast is a nice way to get a good smooth wrap. Even more important, some even downward pressure on the knee can be provided by a second person to simulate weight bearing. Holding the knee steady also allows you to move the foot beneath it into alignment.

Got Latex?

We often receive questions about whether our products contain latex. Because of the prevalence of latex allergies, neither our products nor any of the supplies we use or sell contain latex. We are latex-free.

We do use thinned-down rubber cement, which contains some latex, in one production stage. Though we clean it off, a very small trace may remain. If you’d like us to super-clean the brace because of a latex allergy, please let us know.