Removal of a Total Contact Cast
Featuring James McGuire, DPM, PT, CPed, FAPWHc
Thu, 01/04/2024 – 13:49
Removing the total contact cast is, to some people, a scary process because they’re using this very loud saw. And we’re going to go through some of the characteristics of the saw, but what’s important to keep in mind is that the blade does not spin, it vibrates. So what that means is, if you put it on a surface that can absorb some of the vibration, it won’t cut. Again, the blade doesn’t spin, it vibrates. That vibrating blade will not harm skin if it just touches skin lightly, and that it’s very easy to detect as you move the blade along when you’re going through the actual cast material and going into the padding and the stocking out underneath.
The only things to remember are one, that you just go vertically in and out, that you don’t rotate your hand, and that you don’t drag the saw along. If you’re then careful, and it really doesn’t matter how you hold it or however you like to stabilize yourself, I recommend that you either have your hand stable by touching the cast itself if you have a big hand, or if you have to use two hands on the saw, that you stabilize your elbows so that you’re going in just gently. So you just have to remember that two things, one is you don’t want to put it down on some place where it’s really bony, that’s why the major bones in here are kind of padded up a little bit. The other thing is, what you want to do is just go straight in and out, all the way down, straight in and out.
Every time you feel it go through to the stockinette, you stop, you come back out and then do the next one. It doesn’t have to be slow, you just have to be careful. If you took and dragged this on the patient’s skin, it’s going to scratch them, it won’t necessarily cut them badly, but it will scratch them, and this stockinette is really good at absorbing a lot of that vibration. When you see it pop, you’ve probably got most of the tension off it, you then give it a little pull and see if you actually got it all. If we did, you got it all. Tip it up like this, and at the top, you take your scissor and just cut through the stockinette to release it.
You actually can save the plantar side. Sometimes people make a splint out of this for a patient that you just want to make a plantar splint for, and you can cut the stockinette down the middle and actually use this material to make a splint for a very short period of time, but you can do that. Always put your finger underneath and cut along your finger rather than scraping along the patient’s foot. When you get down here, just change your angle a couple of times. Most of the time when you get down to here, they can slip their foot out.