High-performance activity with below-knee cast treatment, part I: mechanics and demonstration

Much of the disability associated with wearing a below-knee cast is a result of the treatment rather than the disease. A simple practice of placing thecasted limb in a shoe with a cushioned heel to tilt the cast so that the knee is ahead of the ankle at mid-stance reduces this disability. High-performance activity, including participation in sports, is possible in most (including bilateral) cases. Despite increased activity, this method reduces the incidence of cast failure. Healing does not appear to suffer and in some instances may be superior. Mechanics are discussed in Part I, including illustrative cases and comparative evaluation. Part Il will deal with methods of cast application as well as treatment groups that include fracture, Achilles rupture, idiopathic and spastic equinus (not excluding th ose with rocker deformity of the foot) , muscular dystrophy, and a newly proposed disease category made up of ailments that the author suspects share a common cause or aggravating aspect. This latter group includes Sever's disease, adolescent (and occasionally adult) Achilles tendinitis, shin splints, painful kneecaps, and flat feet. Methods of cast application differ for each group. Gait mechanics is reviewed to illustrate similarities when comparing function levels achieved by cast treatment with those achieved by orthotic or prosthetic management.