the all-weather walking plaster
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The all-weather walking plaster
J. Shepherd
The Australian Journal of Rural Health © Volume 3 Number 3, August 1995
Aust. J. Rural Health (1995) 3. 101-105
Clinical Perspective
THEALL-WEATHERWALKINGPLASTER
General Practice, Junlestoml : South _4ustralia, Australia
ABSTRACT: This article descl-&es the application of an all-weather- xalking plaster- designed
spec$cally LO meet the needs of rural patients. It outlines the uduantages of t1zi.s method oner
traditional plaster applications.
KEY WORDS: plaster of Paris, rural genes-al practice.
INTRODUCTION
The ability to construct a walking plaster that is
wet-grass proof, stable am1 allows the patient to
walk, TLIII and work safeb with animals on uneven
ground is an extremely useful skill for rural GPs
to acquire and appl!- to their patients.
While working as orthopaeclic registrar at the
Winchester Hospital in 197.5-76. the benefits of
vigorous mobilisation inside well fitting plasters
were impressed upon me. Repair of acutel!- rup-
tured collateral ankle ligaments was considered
unwarranted because of excellent a&\-e conserv-
ativ~e treatment results from well made plasters.
With critically timed manoeu\-res. the plaster
technician always ensured that the plaster sole
had good application to the instep. and fitted
flatly on the inside of a canr-as boot I(onl!- at the
hee1 and metatarsal heads). He then applied a
thin skin of fibreglass to prol~icle strength and
splash-proofing to the comfortably- moulded plas-
ter of Paris (POP).
On commencing rural practice in the mid-
north of South Australia in 1978. and in the
absence of beautifully made English canms plas-
Correspondence: J. Shepherd, 66 IrCne Street,
Jamestown, SA 5491, .%crstralia.
Acceptedfol-publication Februuq. 1995.
ter boots, I soon found that plasters constructed to
provide a boat or rocker shaped bottom were
vastly superior in durabilit~~ and function to the
old fashioned rubber heels. Rubber heels alwavs
wore through unless the>- were on a heaT-\- base
plate of 14-16 la>-em. which took 2 da>-s to dry,
and they were dangerous and slipperT- on shear-
ing shed floors. I therefore ceased using the rub-
ber heels. The we11 constructed: but initially
expensive, 3M, Zimmer or Biomet boots eventu-
ally replaced the tractor tyre boots or heavy
thongs with stapled straps that had been con-
structed by enterprising farmers to increase the
life of their rocker soles.
CONSTRUCTION OF PL-ASTER
ROCKER SOLE MOULDS
Initially I used fibreglass cardboard boxes as a
foot mould. When pressure was applied a slight
depression resulted which usually matched the
shape of commercial plaster shoes. However I
found that students and trainees could rarely bal-
anee this box against their abclomen. and also
position it at right angles to the vertical tibia1
shaft. I therefore used the boots wrapped in Glad-
wrap as the ‘moulds’. These were excellent pro-
vided the plasterer had enough flat abdomen or
unencumbered chest wall to press these on and
102 AUSTRALIANJOURNALOFRURALHEALTH
FIGURE 1: Plaster mould: Shoe mould is applied to
the plaster board.
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or
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FIGURE 2: Planter grade or up to 5” dorsijlexion.
observe their correct angles. If the plasterer failed
to achieve the correct angle or the shoe bent then
expensive disasters occurred. Three failures and
$100 worth of plaster and fibreglass (at practice
expense) applied by one Family Medicine Pro-
gram (FMP) trainee for a sprained ankle con-
vinced me to ask my Chief Executive Officer to
construct rocker sole moulds that would perfectly
match the boots.
The Chief Executive Officer took the mould of
the upper surfaces of three new small, medium
and large plaster boots and imprinted these into
three wooden trays, filled level with POP. The
trays measured 10, 12 and 14 inches long by 7
inches wide and 1 inch deep. Painted with
FIGURE 3: Rehearsing the angles before applying
the POP
Estapol and used as rigid moulds, these trays
have lasted for 6 years and are extremely easy to
hold against the body and to obtain the correct
alignment (Fig. 1).
A similar type mould could be constructed by
using the plaster shoe with wooden wedges sup-
porting each end and nailed onto a flat wooden
board, as it is important to avoid distortion of the
shoe when pressing onto the foot during the mak-
ing of the rocker sole.
CONSTRUCTION OF PLASTER TO
FIT THE MOULDING BOARD
Prerequisites
Removal of swelling by elevation and serial com-
pression bandaging, with coaxing of the foot to
plantar grade and up to 5 degrees of dorsiflexion
is a fundamental requirement (plasters set in
plantar flexion deny normal gait pattern: Fig. 2).
Rehearsal
The patient’s stockinette and velband should only
be applied aIter achieving the 5 degrees of dorsi-
flexion, following the application of pressure
against the pectorals or lower ribs on the plas-
ALL-WEATHER WALKING PLmISTER: J. SHEPHERD 103
FIGURE 4: Afoulding- the POP JkrniJ- into the irxicp
and the heel.
terer’s chest to comfortabl~~ fill the instep and
avoid eversion or inversion (Fig. 3).
Application
A routine leg POP either abol-e or beloT\- the knee
is then applied, with an eight thickness slab
extending as far as the middle of the metatarsal
heads, and around the convex heel surface. This
slab must be incorporated into the plaster and
then pushed firmly into the instep as rehearsed
(Fig. 4).
Construction of the rocker
(1) The first requirement is to fill the instep.
Take a fresh roll of 6 inch POP. tear off two. three
thickness slabs 6 inches long.
(2) One slab is folded diagonallvm once to gi7-e
a large triangle, and the second slab is folded
twice to give a smaller triangle.
(3) These triangles are then moistened ant1
applied to the instep and coaxed to fill in and
provide a level base to the POP (Figs 3. 6).
(4) A multi-lavered ant1 contoured slab (depending upon the length of the foot) is now
constructed with the remainder of the 6 inch roll
(Fig. 7). It is immersed, wrung out, and then
applied and pressed hard onto the sole I~!- the
plaster mould board, with the edges Cgorously
FIGURE 5: Thefilled instep.
FIGURE 6: Filling he inslep.
r
L
FIGURE 7: .IIuking the rocke7- base.
crimped in beneath the margins of the foot to
ensure that the mould is completely filled (Figs 8,
9).
AUSTRALIAN JOURNAL OF RURAL HEALTH
FIGURE 8: Applying the rocker base.
FIGURE 9: Modding the rocker base with the plaster
mould.
(5) When the plaster is almost set, the board
is wriggled slightly side to side to free it from the
plaster and the rocker surface is then firmly ban-
daged on with 12.5 cm fibreglass (Fig. 10). One
roll extending 12-15 cm above the ankle is usu-
ally enough. The POP will fit the boot exactly,
provided the mould is made to match the boot.
A useful trick to increase the durability of the
sole is to apply two longitudinal layers of fibre-
glass to the sole first, starting at the Ieading edge.
The third layer is then run backwards around the
instep and up and over the forefoot to anchor the
FIGURE 10: Fibreglass rocker base.
FIGURE 11: All-weather walkingplasters remain
strong qfier considerable use.
first two layers in place. The application of the
extra layers of fibreglass to the sole of the plaster
usually means that farmers can leave their dirty
thongs or shoes at the door of the house and walk
inside the house on the plaster itself without it
wearing out over 6-8 weeks. Following applica-
tion, 24 hours of non-weight bearing is required.
Graduated walking (depending upon the reason
for POP) is then commenced.
PITFALLS INVOLVED WITH
APPLICATION OF THIS PLASTER
(1) Slight ankle extension (plantar flexion)
which causes breaking of the plaster each side of
the forefoot and cracking and breaking above the
ALL-W-EATHER WALKING PLASTER: .I. SHEPHERD 105
ankle. The patient will also have chafed the front
of their shin.
(2) Rolling back the stockinette over velband
or plaster at either end of the plaster can cause
dangerous constriction bands inside and out of
sight. This can be avoided by radial cuts to any-
protruding velband or plaster before carefully
turning back the stockinette.
(3) Leaving a thick ridge of plaster at the
anterior and lower edge of the sole can cause
painful indentation in the skin of the metatarsal
heads. It is better to leave a tapered edge allow-
ing contact and weight-bearing b!- the front of the
metatarsal heads and toes.
The final test for your plasters will be whether
they last the distance and can still stand by- them-
selves, stable and solid after 200 km of road work
(Fig. 11).
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