562 CHAPTER 59
Straightening a leg that is hard to stretch
In an older child who
has a knee contracture
with strong muscles that
bend the
knee, it may
be hard to
straighten
the knee
more with
each cast
change.
STRONG
MUSCLE
HERE
If the leg does not
move when you pull
it, ask the child to…
Straightening a tiptoe contracture
When he relaxes, keep
pulling, and the leg should
straighten a little.
Repeat this several times while you
steadily pull the leg. Each time the
knee should straighten a little more.
A foot with a
contracture
like this,
tight
heel
cord
Put lots of
padding under
the cast on top
of the ankle.
can sometimes be
Try to overcorrect
Do not let the child
straightened with
casts and wedges.
the contracture
so that it will
rest easily at a
walk on the cast until
the day after it is put
on—and then only
(90°) right angle
if you put a ‘walking
when the cast is
heel’ on it. Otherwise
removed.
the sole of the cast will
become floppy and
will not help. Active
children need very
thick plaster on the
Be sure the cut
bottom of the foot.
reaches fairly
high up the ankle
wood or rubber
(not across the
walking heel
top of the foot).
CAUTION: The above
method of correcting
tiptoe contractures
sometimes causes
pressure sores here.
To prevent
pressure sores, it
often works better
to cut a complete
ring out of the cast.
For more
precautions, see
p. 567, on the
casting of club feet.
For the child who lives too far away to have
her cast changed every few days, you can
try to make an aid that will gradually pull
the foot up without needing frequent cast
changes. Here is one idea:
strip of car
inner tube
Bend the cast
edges outward
with pliers so
they will not
dig into skin
as foot rises.
bump to keep inner
tube from slipping
strong reinforcement
of plaster
Put lots of padding
under the heel.
CAUTION: lf the child is sent home with a cast be
sure the family knows the danger signs. If any of these
appear, have them quickly bring the child back or
remove the cast themselves.
Danger signs:
• constant, severe pain—especially in areas where
pressure sores can occur
• a darkening or change of color in the toes
• numbness or burning
• a smell like rotting meat (a late, very serious sign)
To take off the cast without tools, in an emergency,
soak it in warm water and unwrap to tear it apart.
Note: This cast is not as strong as a fully covered one and will not last on a very active child. It will
usually only work on a child without much sideways deformity of the foot or ankle. The cast may need to
be changed 2 or 3 times as the foot straightens.
Disabled village Children