A Patient's Guide to Instructions for Patients in a Leg Cast

• Peripheral neuropathy (altered nerve sensation)

• Spinal cord injury

• Neurological conditions, such as cerebral palsy, that affect sensation and may cause spasms

• Diabetes

• Any conditions that may affect your circulation (cardiac problems, Raynaud’s disease)

• Conditions/treatments that may affect the integrity of the skin (steroid treatments).

If you are aware that you suffer with these or any other conditions please let the Plaster Department staff know. You may need to come back more often to check the condition of the skin under the cast. In addition, Plaster theatre staff may ask to contact you, a week after surgery to check all is well.

DO keep your leg elevated, preferable to heart level as this will help prevent/ reduce swelling. If it is left down for a period of time you may find it will swell, the cast will feel very tight and it could restrict the circulation to your limb. Ensure that you do not rest the plastered leg on the heel for long periods. If your cast becomes loose contact the Plaster Department. If left, your cast may rub and cause a sore.

If the toes on the affected leg changes colour, for example, blue or red or white and is associated with pins and needles, pain or swelling that is NOT RELIEVED BY HIGH ELEVATION for 30min, then your cast could be restricting your circulation or pressing on a nerve and needs to be assessed. You should contact the Plaster Department immediately. If it is out of hours or the weekend then you should go to your local A&E Department.

DO contact Plaster Department if you are experiencing any burning sensations, blister like pain, wetness or stickiness, offensive smell or discharge from under your cast. You may have developed a sore or have a wound infection and should be seen immediately.

DO exercise all other joints not in the cast, as this will help prevent any stiffness, and improve the circulation to your limb.

DO keep your cast dry, at all times. Protective waterproof covers are available for purchase for bathing/showering. Leaflets are available in the Plaster Department.

DO contact the Plaster Department if your cast becomes cracked or soft or broken, as soon as possible to arrange an appointment for it to be assessed.

DO NOT push anything inside your cast, you may damage the skin and it could become sore or the object stuck inside. If this occurs you must contact the plaster Department to make an appointment to be seen as soon as possible. Avoid putting talcum powder inside the cast as it is not good for the skin under the cast. Creams and other lotions will also make the lining of your cast sticky and may also make your skin macerated.

DO NOT - Weight bear on your cast unless told to do so by your doctors. If you are allowed to weight bear, you will be given a shoe to prevent you slipping and prevent your cast from becoming damaged. You may still need to use your crutches or walking aid for stability.

Do not alter or cut your cast - you may reduce the effectiveness of it and you could injure yourself in the process. Please contact the Plaster Department for a review.

• If you feel unwell and have a temperature and do not have a cold or other illness, please consider that it may be to do with your surgery or the cast. Contact the Plaster Department for advice.

• Patients with reduced mobility have an increased risk of developing a blood clot (known as a deep vein thrombosis or pulmonary embolus. Please follow your medical team’s instructions regarding anticoagulant therapy. If you experience any of the following symptoms please contact your local Accident and Emergency room or the Plaster Department to seek urgent medical assessment.

Symptoms can include;
• Pain in calf or thigh or chest
• Shortness of breath with no physical exertion

• Pressure ulcers in cast (sometimes known as a pressure sore or pressure related injury). A pressure ulcer is localised injury to the skin or underlying tissue. This is usually over a bony prominence and as a result of sustained pressure over a period of time. It can also be associated with shearing forces. The pressure reduces the blood supply to that area, and if prolonged can cause damage to skin and soft tissue. Patients with an already reduced blood supply are at much higher risk of developing problems. Do change position and mobilise on a regular basis. This will do two things, encourage your circulation and help reduce the risk of developing pressure sores inside your cast on areas such as the heel. Also try and support the limb with pillows or cushions, leaving the heel free of pressure.

If you have complex needs, or you are caring for someone with complex needs, do not hesitate to contact the Plaster Department or your medical team to discuss.