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The impression casting should be done with the patient lying down, to prevent them from visualizing the procedure and inadvertently altering the position of their foot in an effort to assist you in your impression casting.

 

Place a towel or pillow under the hip of the same side as the foot you are casting to bring the foot up to a vertical position

 

-The optimum position for impression casting

Lay out all impression casting materials in advance:

 

4 - 30”x5” plaster splints (two for each foot).  The splints should be folded in half to 15”x5”

2 - gauze pads

A bowl of warm water

A couple of paper towels for cleanup

 

Measure one dry splint against the foot from just shy of the 1st metatarsal head, along the back of the heel, to just shy of the 5th metatarsal head.  Trim excess.

1.    Hold each end of the splint in your hands and submerge in water

2.    Once wet, lower the splint into the palm of one hand

3.    Squeeze the splint to remove excess water

4.    Stretch the splint to remove all wrinkles.  Fold the top 3/4” in order to reinforce the cast.

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Place the moist splint on the foot so it extends from just shy of the 1st metatarsal head along the back of the heel to just shy of the 5th metatarsal head as shown above.

 

The splint should extend just shy of the malleoli.

Fold one side of the splint just over the center of the foot as shown.

Fold the other side of the splint over the center to seal up the bottom of the cast.  Use your fingers to smooth the bottom of the cast.

 

The excess plaster, indicated above by the arrow, should be pushed over the back of the heel, NOT left on the plantar surface.

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Moisten the second splint the same as the first.  All the splint to hang over the toes.  1/3 above the toes and 2/3s below the toes.

With one finger under the splint, fold one side over and then the other.  Use your fingers to smoothen the cast to match the bottom of the patients foot.

Push the excess plaster off of the plantar surface and up onto the toes.  Rub the cast into the contours of the foot leaving the cast with a smooth finish.

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Place the gauze over the sulcus and interspace of the 4th and 5th toes.

Hold the foot in a neutral position.  When working on the right foot, as shown, feel the head of the talus with your right hand by using your right thumb on the medial side and index finger on the lateral.  Press on the sulcus and interspace of the 4th and 5th toes with the thumb of the left hand.  Be sure to not allow the foot to move from the neutral position.  Hold the cast until the plaster dries, indicated by  an audible tap on the plaster.

To begin the removal of the cast you must first pull the skin away from the plaster as shown.

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Gently pull the top of the cast on either side of the heel straight down.  This will separate the cast from the heel.

Once the posterior end of the cast is below the heel, you may slide the cast forward along the plantar surface and off of the foot.

After the cast has been removed, inspect to see that the plantar surface has made a smooth mold of the patients foot.

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Allow the casts to dry intil firm.  Make any necessary marks in the casts in accordance with any modifications that are necessary.  Write the patients name on the bottom  of both casts.  Rubber band the casts together along with the Rx.  Be sure to pack the casts with a protective material such as newspaper or bubble wrap.  Multiple casts should be shipped in the same box when possible.

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