The golden rule: never play alone with casts you cannot remove yourself immediately, and always keep tools within reach that can get the cast off in minutes. Tingling, discolouration, numbness or increasing pain: the cast comes off right away. No discussion, no "just a little longer".
Before you start
- Consent first. Discuss beforehand what will happen and for how long, and agree on a safeword or stop signal. Whoever is in the cast must always be able to end it.
- Health check. Do not play with casts if you have diabetes, vascular problems, (a risk of) thrombosis, skin conditions where the cast will sit, or during pregnancy, without consulting a doctor first.
- Practise dry. Wrap a few times with padding only (synthetic cast padding) before using plaster, so the wrapping technique becomes second nature.
Applying it well
- Stockinette first. Pull a tubular bandage (stockinette) over the limb. It protects the skin and gives neat edges.
- Pad generously. Wrap at least two to three layers of synthetic padding, extra thick over bony points such as ankles, elbows and the base of the thumb. Padding is your most important safety margin.
- Not too tight. Lay the plaster on, do not pull it tight. The bandage should follow the limb, not constrict it. A cast supports through its shape, not through pressure.
- Neutral position. Cast joints in a comfortable, functional position: a wrist slightly extended, an ankle at 90 degrees. A forced position becomes torture within an hour.
- Fingers and toes free. Always leave finger and toe tips visible, you need them to check circulation.
Checking circulation (CSM check)
Check after application, after half an hour, and every hour after that: Circulation, Sensation, Movement.
- Circulation: squeeze a nail until it turns white; the colour must return within 2 seconds. Fingers or toes turning blue, white or cold are an alarm signal.
- Sensation: tingling, numbness or a "pins and needles" feeling that does not fade means: cast off.
- Movement: fingers and toes must move freely. If that decreases, there is too much pressure.
Know the risks: a cast that is too tight can cause compartment syndrome, a medical emergency. Increasing pain out of proportion to the situation, pain when stretching fingers or toes, or a tense, full feeling: remove the cast immediately and seek medical help if symptoms persist. Just be honest about what you were doing; doctors have genuinely seen stranger things.
Wear time
- Start with short sessions of an hour or two, and only build up if everything stays comfortable.
- Sleeping in a cast is possible for experienced wearers with a well-applied, generously padded cast, but never with your first casts, and never home alone without removal tools within reach.
- Long-term wear (days) means real muscle loss, stiff joints and skin problems. Know what you are doing, schedule rest days and listen to your body.
- Walking with a leg cast: use a walking heel or cast shoe plus crutches. Your balance really is different from what you expect.
Safe removal
- Plaster shears and bandage scissors with a blunt tip work fine on thinner casts and are the safest option for beginners.
- An oscillating cast saw is the right tool for thick casts. The blade oscillates so it does not cut skin, but it can graze and get hot: saw in short strokes, lift the saw each time, and never saw over bony points without extra caution.
- Soaking in warm water with some vinegar softens plaster of Paris, slow, but it works when you are not in a hurry.
- Fiberglass does not soften in water and is tough on scissors. Only apply a synthetic cast if you own a cast saw.
Community tip: when applying, run a smooth, sturdy strip (a length of plastic, for instance) under the padding along the line where you plan to saw or cut later. That gives you a guaranteed safe cutting line.
Skin care
- Never poke objects into the cast to scratch, small wounds under plaster get infected quickly. A hairdryer on the cold setting through the opening helps against itching.
- Keep plaster dry. A wet plaster cast loses its strength and wet padding irritates the skin.
- After removal, care for the skin with a mild lotion and give it a day of rest before wrapping again.
Questions about materials or technique? Ask them on the forum, the community is happy to help you get started.