Lower Limb Cast Care Information – For Patients/Carers of a Patient

  • Reference Number: HEY-506/2018
  • Departments: Orthopaedics

Introduction

This leaflet has been produced to give general information for patients (or carers of a patient) with a lower limb cast.   Most of your questions should be answered by the Cast Care Advice sheet which should be enclosed with your/the patient’s documents.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you/your patient.

Cast care information

Your cast has been applied to keep your injury from moving so that you feel less pain and to help the healing process.

  1. A Plaster of Paris cast takes 24 hours to dry.
  2. A synthetic cast takes one hour to dry.
  3. Casts must be kept dry at all times.
  4. Elevation is important to reduce swelling.
  5. Leg casts must not be walked on unless you are specifically advised that you can do so. (If you / the patient are able to walk with this cast, you will be provided with a shoe which must be worn).
  6. Movement of joints and digits (toes, knees and hips) outside of the cast for 5 minutes in every waking hour is extremely important. Please read specific cast care advice sheet enclosed with patient documentation.
  7. Do not poke anything down the cast as this may cause a sore, do not add any extra padding as this may make the cast tight.
  8. Do not use a sunbed whilst wearing a cast.

If you drive a vehicle with a cast on you, may be liable to prosecution under the Road Traffic Act 1988. Please check with your insurance company that they still provide cover.

Complications that may occur whilst in a cast

If any of the following occur contact the Fracture Clinic medical staff. In an emergency when the clinic is closed, contact the Accident and Emergency department.

  1. Increased pain that is not helped by pain relief and rest. Any pain in the calf.
  2. Swelling, numbness, blueness, paleness or discolouration which is not bruising.
  3. Pins and needles.
  4. You / the patient are unable to move your/their toes/ankle/knee/hip if not in cast.
  5. You / the patient feel a burning sensation under the cast as this could be a blister or sore.
  6. Any discharge or smells which come through the cast.
  7. An object gets dropped down the cast.
  8. The cast becomes loose or tight.

Treatment to reduce the risk of thrombosis (blood clots) of the lower leg (Patients over 18 years of age)

There are two treatment options to reduce the risk of venous thromboembolism (blood clots) in the deep veins, (mostly in the lower leg or in the lungs called a pulmonary embolism). Patients assessed as requiring this will be given the option of two treatments for blood thinning medicines.

Orthopaedic/fracture clinic staff to complete the box below for those patients assessed as requiring treatment:

Subcutaneous Injection – Dalteparin (Fragmin) YES/NO
Capsule – Dabigatran YES/NO

If you do develop cramps, calf pain or swelling, breathlessness or chest pain, please contact the hospital urgently.

Care when in a lower limb cast

  1. Leg to be elevated on pillows higher than the height of your/the patient’s heart (2-3 pillows required). Pillows to be placed under thigh and calf (not under heel), to prevent pressure on the heel. Heels should not be rested directly onto the bed.
  2. When you/ the patient is seated in a wheelchair/chair, the leg should still be elevated on a stool with a pillow placed under the calf to protect the heel from pressure.
  3. Please check the top and bottom of the cast daily for any redness, undue swelling, blistering or broken skin. Report to the Fracture Clinic immediately if any smells or staining come through the cast.

Removable casts

If the doctor has said you may remove your cast for bathing, you may need someone to help you to do this.

If the doctor has said that the cast is to be removed for physiotherapy or wound checks, then it should not be removed at any other time as this may affect your injury.

To remove a cast with Velcro straps or bandage, undo the strap or the bandage. Spread open the flexible section of the cast using your hand, you may need help to do this and carefully lift the limb free of the cast.  To reapply your cast, reverse this procedure: please be very careful to make sure that your leg returns to the position it was in before you removed the cast.  Make sure the straps or bandages are firmly fastened but are not overly tight.

DO NOT stop wearing your cast until your doctor has said it is safe to do so.

Orthopaedic/fracture clinic staff to complete

Can the cast be removed daily for hygiene and skin check? Yes / No / Not Applicable
Can the cast be removed for exercises? Yes / No / Not Applicable
Can the cast be removed to have a bath or shower? Yes / No / Not Applicable
Was the skin intact prior to cast application? Yes / No / Not Applicable
Is there a sore, wound or suture present? Yes / No / Not Applicable
If the answer to the previous question is YES is a district nurse required? Yes / No / Not Applicable
Has this been arranged? Yes / No / Not Applicable
Has the home been contacted and verbal information given about the patient’s treatment and care? Yes / No / Not Applicable

Contact the fracture clinic for advice

If you develop complications or require further advice on the issues contained in this leaflet, please do not hesitate to contact the Fracture Clinic or the Emergency Department on the following numbers.

Fracture Clinic (01482) 674378 / 674380

Children’s Fracture Clinic (01482) 675731

Emergency Department (01482) 674561

If it is a non-emergency and you reach an answerphone, please leave a message and we will get back to you.

The Fracture Clinic staff are available to visit inpatients on a hospital ward to give advice.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.