Footwear Casting

• Mark
  • 1st and 5th Met Heads
  • malleoli and bisect horizontally
• Posterior Slab
  • Measure plaster roll from 1st met head over heel down to 5th met head
  • slab should be at minimum 2 sheets thick
• Anterior Slab
  • Measure plaster roll from 3 inches above 1st met head around toes to 3 inches above 5th met head
  • slab should be at minimum 2 sheets thick

• Patient to be seated with knee at 90° and foot flat on open box
• Align foot to subtalar neutral
• Assist the pt to press foot into box ensuring foot remains in subtalar neutral
  • Keep one hand on foot and the other on the knee
  • Ensure foot down to the bottom of the box
  • Press all toes down 
• Remove foot carefully
• Record patients details on the box

• PT to lie prone on bed with feet off end of bed
• Mark bisection line through calcaneous and achilies
• Use one hand to place foot into plantar grade postition
• Use other hand to palpate talus 
  • Once both medial and lateral border is felt equally this is subtalar neutral

Natural positioning should be between 2° and 8° any more will show ankle instability

Cast

• Wet posterior slab and squeeze out excess water
• lay across heel aligned with 1st and 5th met head markers, ensure level with malleoli biscection lines
• cut slab at centre of heel
• wrap medial flap across sole of foot and tuck under lateral flap, smooth and contour to foot
• wrap lateral flap over medial, smooth and contour to foot
• wet anterior slab and squeeze out excess water
• overlay onto foot covering distal end of toes
• smooth plantar side of plaster leaving dorsal open 
• Position foot into subtalar neutral using pressure on 4th&5th met heads (once cast set push out this impression)