A Cast of Characters

It’s always so much fun to regale my audience in the blogosphere of the thrills and chills that occur in a daily basis in my NYC podiatry practice.  Just a few weeks ago, I was fortunate to place a below-the-knee fiberglass cast on the leg of a patient with an unstable fracture of the first metatarsal, something I don’t often do.  Back in the day, many of my NYC podiatry patients had the singular pleasure of experiencing the confining, claustrophobia-inducing, life-altering pleasure of a hard cast.  Before my time it was plaster – wet, hard, and heavy.  By the time I started practicing in the halcyon days of the Bush administration (that’s W. to you, thanks) it was fiberglass – lighter and dryer, but still hard and heavy.  Now cast placement is relatively rare, and here’s why.


In the early days of orthopedic and podiatric surgery, it was all about immobilization.  Keep a fracture immobilized as long as possible, and it will heal well.  Don’t move a leg, foot or shoulder after surgery for as long as possible, and range of motion will eventually return.  Well, that wasn’t entirely true.  As some knew a long time ago, and most know now, return to activity after surgery or injury is all about early range of motion.  Surgical procedures, hardware and fracture braces and boots were designed and adapted to conform to this principle.  Internal hardware used to stabilize bones and joints after bunion surgery, fusion procedures, or compound fracture was designed with an eye for early range of motion.


For example, the foot that walks in a regular shoe within 2 weeks after bunion surgery recovers far faster and better than the foot that spends 6 weeks in a surgical boot.  The window of opportunity for recovering range of motion is best captured 2-6 weeks after surgery.  And patients who have undergone hip or knee replacements start passive range of motion in bed almost immediately after surgery and are typically walking the day after surgery.  Even more complex and extensive bunion surgery procedures walk in a fracture boot one week after surgery, rather than staying in a fiberglass cast for 6 weeks after surgery, as was the norm.  Fractures too, are walked in a boot at a much earlier stage in order to capture and maintain range of motion.  And the outcomes are consistently better.


So if you are planning a surgery, or have the misfortune of a fracture or other injury, don’t expect the respite and pleasure of a lovely fiberglass cast.  Get ready to work it baby, and start walking it.  Unless of course, you are seeing someone else.  But why would you do that?


See you in the office.


Ernest Isaacson