Application Technique Big Toe

Indications:

  • Big toe fracture.
  • Dislocation of the big toe.
  • Fracture of the distal 1st metatarsal.
  • Hallux valgus.
  • Positioning splint.
  • Physio purposes.
Application: The materials should be pre-prepared to enable rapid application of the bandage. All the necessary materials should be placed within reach to avoid hold-ups in the procedure.

The patient should be in a position which is comfortable to him/her and the person applying the bandage. This may vary depending on the extent of the injury, the diagnosis, the treatment method and the patient's condition.

Materials required: 1 x 5 cm Delta Cast Conformable polyester support bandage and hydrogel-coated casting gloves, fleece padding or toweling tubular bandage, adhesive bandage, 2 cm strip of X-ray film, bandage scissors, felt-tip pen.

Photo 1:
The fleece padding is placed around the big toe and middle foot area. Alternatively, a toweling tubular bandage can be pulled on. A strip of unusable X-ray film is inserted at the side beforehand. The cast is wrapped around the big toe to above the foot area using circular movements. For effective immobilization the following number of layers should be applied: 3 layers in the big toe area, 3 to 4 layers in the big toe basal joint area, 2 layers in the middle foot area. This type of application produces optimal stability whilst retaining flexibility. The cast should be applied relatively tightly (extending it by about 70%) thereby achieving the best fit and bonding of the layers.

Photo 2:
The cast is molded to the big toe and foot area for four to six minutes.

Photo 3:
Following the molding phase, the cutting lines are marked and the cast opened on the outer lateral side using bandage scissors. If the dressing has been applied too tightly it will loosen by itself after opening (special feature of Delta Cast Conformable). The dressing is trimmed for individual fit.

Photo 4:
The fit of the cast on the patient is then checked.

Photo 5:
The cast is fixed in place with an adhesive bandage ending above the ankle joint taking into account the state of the swelling. This prevents movement of the cast under load.

Photo 6:
Finished big toe cast. The upper ankle joint retains movement and normal shoes can be worn.

The small number of layers means that the cast remains semi-flexible and can be adjusted depending on the individual state of the swelling (looser or tighter). To do this, the adhesive bandage is removed and the cast altered for a perfect fit. Re-application is carried out as described above.

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Variant:

Hallus valgus redression cast: Here the cast is split medialy not lateraly and a 2 cm wide strip cut out of the area of the big toe. The cast bridge in the 1st interdigital space is kept, with this the redression of the big toe is done. The big toe is released from pressure medialy and put under interdigital pressure at the same time.

Forefoot-quiver: Here the cast gets wrapped distaly around all toes in 3 layers and split dorsaly. It gets cut away from the toes dorsaly, a plantar toeplate of cast is kept. This aids the stabilization of big toe fractures.

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