There are a variety of casting techniques used for custom AFO’s or custom ankle braces. The video describes the best casting techniques and strategies that can be used to optimize custom bracing outcomes.
Video Transcript:
What the foot looks like in a neutral position when you get this…So what we try to communicate to our customers is that that having a design that’s a semi-weight bearing cast in the neutral position with the patient sitting on a chair…it’s not fully weight-bearing. You don’t want a fully weight-bearing cast because then you can’t possibly provide any pressure at all. So it’s our contention that a semi-weight bearing situation like this will give us the opportunity to correct for the pathology without distorting the cast to the point of which it’s really a shot in the dark.
So, I’m going to show you techniques for making this cast and techniques for making this cast and I know I’m talking to a bunch of people who cast all the time so I’m not sure what I can offer, because I cast differently. I know I cast differently than you guys because I’m not interested in casting people for broken tibias. I don’t need to make my cast really thick, in fact, the thicker I make it, the worse it is later. So I want a nice thin cast. That’s what I want. I usually put up some sort of tubing or something so that when we cut it off…
It’s also good to have like, a plastic bag underneath there but you don’t have to. For years I was just putting one of these…and I always wrap a couple of extra layers around the heel. That seems to be a challenging area to get a complete coverage on but you really don’t need more than two layers. Some people use a casting board so they’ll they’ll try to mimic that down wrap that I talked about on the shoe in the floor and they’ll put the foot on a little bit of a heel lift, maybe 3/8 of an inch. That’s okay but the truth is the plant is fine because when we modify the brick, we modify the cast, it’s easy for us to put in that shape and we don’t really need it in the cast. The scissors did not cut this. A cast saw did, right?
Okay, here’s another technique for casting. This technique I’m going to show you here is the one that uses the SDS sock which is just a impregnated sock you roll it up. It’s a pretty good way of going. Using two and a cutting strips, so two things. This time we’re taping it on the patient first. Then we put the plastic bag on to prevent air from being ripped off. Then we duck this in water. You’ve got to really squeeze it well. You guys know that. It’s a little bit of a struggle to get it up on the foot, so you massage it a few times. You get it all the way up there nice and you set it down. This practitioner liked using foam underneath the foot. I don’t think that’s too bad to use foam on the foot. He used too much. It was like an inch and a half thick. I think if you’re going to use foam, I think a half an inch is as much as you want to use, but, theoretically you get a better contour to the bottom of the foot that way and that’s true. So what he did is he used a letter opener and he trimmed the letter opener so that it became almost like a scalpel. So once you pull out the tube what remains is that strip to protect the patient still and you’ve left the tunnel. And so they don’t use a cast saw at all. They just use this letter opener that’s been modified, as you can see, to run it up the cast. Be careful of the end there. You don’t want to hityourself in the face, okay.
It’s a little bit of a struggle towards the end. You also kind of want to do this when it’s fresh. You don’t want to let it set completely, otherwise you’ll never be able to manage this. We love the STS sock. That’s the easiest one for us to manage. It fills nicely. We can pull it off the cast easily. We don’t have to use any separating agent.