|SSM Cardinal Glennon Children's Medical Center|
What to Expect When Your Cast Comes Off
So you're getting your cast removed soon — and you probably can't wait to get back to your normal activities. But it's not as simple as "goodbye, cast; hello, hockey" (or football, basketball, lacrosse, or whatever your sport of choice is). It will take a while for everything to get back to normal. While it does, you'll need to give your affected limb a little extra care and avoid some physical activities.
Here's what you can expect in the coming days and weeks as your cast is removed and your limb finishes the healing process.
What Will the Doctor Do?
Before removing the cast, the doctor will examine your limb. He or she may want to take an X-ray of the limb in the cast and check things like your pain level.
If everything seems OK, the doctor will remove the cast with a saw, but there's nothing to be afraid of. It's a special saw with a dull blade that vibrates up and down. The vibrations are enough to break the cast apart, but they won't hurt your skin, although they might tickle a bit.
Once the limb is out of the cast, the doctor will examine it again, checking for pain and seeing if you have a good range of motion. If you still have some pain or difficulty with motion, the doctor may give you a splint to wear until the limb heals more. Your doc might even decide that you'll need a different cast or one that is shorter than the one you have now.
If you'll be having a leg cast removed, bring a loose or larger-than-normal shoe with you to the doctor's office, as there is a chance you might have some swelling in your foot.
What Will My Limb Look Like?
Don't be alarmed, but there's a decent chance your limb might look a little odd when the cast comes off. Your skin might look dry, scaly, flaky, or pale, and the hair on your limb might seem darker and thicker than usual. Your limb might even smell a little bit (after all, it's been in a cast and not washed for a while!). All these changes are normal. They should clear up fairly quickly so there's no need to worry about them.
The muscles of your limb will likely appear smaller and weaker (what doctors call "atrophied") because you haven't been using them. This is normal, too, but it will take a little longer for your muscles to get back to their original state than your skin. You'll need to take it easy and limit your activities during this time.
What Should I Do When I Get Home?
You may be tempted to scrub or scratch all the dead skin off your limb the moment you get home. Resist the urge. Your skin is going to be very sensitive for the next few days and you'll need to treat it delicately. Instead of rubbing, scrubbing, or scratching your skin, gently wash it with mild soap and soft cloth or gauze pads.
If you had an open wound when your limb was broken or fractured, your skin may have scabs on it when it's removed from the cast. Don't scratch the scabs as this could damage the skin and possibly lead to an infection. If there's still an open wound, follow your doctor's instructions on how to take care of it.
If your limb was in a cast for 3 weeks or more, soak your skin in warm water for 20 minutes twice a day for the first few days after the cast is removed. Gently rub your skin dry with a soft towel. The key word here is "gentle." Rubbing the skin too hard can damage the new skin.
After the support provided by the cast is gone, people often notice stiffness, pain, and swelling in the limb. Be sure to support your limb as it continues to heal, and move gradually back into using it. Start with small, easy movements and work your way up to using the limb fully.
Keep your skin soft and help speed the healing process by applying lotion after you clean the area where the cast was. This will also help stop itching. Choose a fragrance-free lotion because perfumes can irritate skin that's delicate or sensitive from being in a cast. Lotions made with cocoa butter work particularly well.
If you've just had a cast removed from your leg, avoid shaving the hair on your leg for about 3 days after the cast comes off to give your skin time to recover.
What Should I Do Over the Next Few Weeks?
You'll want to start alternating gentle movement exercises and periods of rest for your limb right away. Be sure not to overtax your limb, though. Remember that your muscles will be smaller and less effective than they used to be for at least a couple of weeks.
Ask your doctor about when you can start doing your normal activities again. He or she will decide when this is right based on a follow-up examination and X-ray. Doctors want to see that bones are completely healed before they give patients the go-ahead to start more strenuous activities.
Every situation is different, but a general rule of thumb is that you should avoid strenuous activities for as long as your limb was in the cast. You'll be able to go back to doing most hobbies and light activity earlier, but sports will have to wait a little longer.
People can usually resume non-contact sports after about 4 to 6 weeks. Returning to full contact may take 8 to 12 weeks or more. It's all about when the doctor decides your bone is fully healed and has the strength and range of motion to withstand the rigors of your particular sport.
If you have any difficulty moving the limb, your doctor may recommend that you wear a splint for the first week after the cast is removed. The doctor may also recommend therapy to help you regain a full range of motion in your limb:
Before recommending an exercise program, a therapist will evaluate your affected limb, including assessing strength and pain, measuring swelling and range of motion, and checking the status of skin and scars. Once the evaluation is complete, the therapist will assign you one or two simple exercises to start with. If you respond well, the therapist will gradually add other exercises.
Therapy also can include massage and a regimen of hot and cold packs, which will help keep any swelling down and increase circulation, which helps promote healing.
What If Something Seems Wrong?
Your doctor will probably schedule a follow-up visit for a few days or weeks after you get the cast off to check that your bones are healing as they should. (When and how often you go for follow-up exams depends on your injury and whether you had surgery.)
But if your skin doesn't seem to be healing properly after a couple of days or if you have any pain, don't hesitate to call your doctor's office.
In the coming weeks, be sure to follow your doctor's or therapist's instructions to ensure that your skin, bones, and muscles heal the way they should.
And be careful not to fall on your affected limb while it's healing. You're about to get out of a cast. You don't want to end up right back in one.
Reviewed by: Joseph Basante, MA, MS, CHT