6 Casts

Choosing and applying support

When a limb has a fresh injury and substantial swelling, a splint is generally safer initially than a tight circumferential cast. A splint can accommodate swelling better because it does not surround the limb completely; casting can be considered as swelling subsides.

During cast application, padding should protect the skin without being tight. Mold the cast with the palms rather than the fingertips to avoid creating pressure indentations.

Check circulation and movement

Perform a neurovascular assessment immediately before and after cast application. Compare distal color, temperature, capillary refill, sensation, and movement, and check a pulse when appropriate. Comparison helps identify changes in circulation, sensation, or motor function.

A normal pulse alone does not rule out a developing problem. Worsening pain, sensory changes, or reduced movement also need prompt attention.

Care for a cast

During the first few days, elevate the limb above heart level when possible to help reduce swelling. Gently move exposed fingers or toes to maintain movement and support circulation.

Keep the cast clean and dry. Do not put objects inside it to scratch an itch, and do not cut, trim, or otherwise alter it. Follow the care team's instructions about weight-bearing; bear weight only if the team has said it is safe. Follow the instructions for follow-up appointments as well.

Report a cast that is cracked, soft, or unusually loose to the care team.

Recognize warning signs

Increasing or uncontrolled pain, numbness or tingling, marked swelling, changes in color or temperature, or difficulty moving exposed fingers or toes below a cast warrant prompt medical attention. These symptoms can signal excessive pressure or impaired circulation, including a serious complication such as compartment syndrome. Seek urgent assessment rather than waiting for a routine appointment or trying to adjust the cast yourself.

Calf pain or swelling with a lower-limb cast may indicate deep vein thrombosis or another serious complication and needs urgent medical attention. Sudden chest pain or shortness of breath requires emergency evaluation.