Dr. Shivam Mehra, Department of Orthopaedics, Mehra Hospital and Research Institute, Luknow, Uttar Pradesh, India. E-mail: drshivammehra@gmail.com
Abstract
Introduction Conservative management of foot fractures commonly involves immobilization using synthetic (fiberglass) casts; however, these are frequently associated with structural failure at high-stress points, particularly the heel, due to repetitive weight-bearing. Although patients are routinely advised to use a plaster shoe to offload pressure, compliance is often inconsistent in real-world settings. This study evaluates whether a socket-type breathable mesh cast offers superior resistance to heel breakdown, even in the presence of variable patient compliance.
Methodology A prospective comparative study was conducted on 220 patients with foot fractures managed conservatively using below-knee immobilization. Patients were equally divided into two groups: • Group I: Conventional synthetic cast (n=110) • Group II: Socket-type breathable mesh cast (n=110) Patients were categorized as compliant or non-compliant with plaster shoe usage and followed for 4–5 weeks. Outcome measures included heel integrity, cast breakage, need for reinforcement or reapplication, and patient comfort.
Results Heel breakage in the synthetic cast group was observed in 13% of compliant patients and 50% of non-compliant patients. In contrast, the mesh cast group demonstrated only 2 cases of below-knee cast breakage overall. Overall failure rates were significantly lower in the mesh cast group compared to the synthetic cast group. The breathable mesh cast also demonstrated superior patient comfort and reduced dependence on patient compliance.
Conclusion Socket-type breathable mesh casts provide a more reliable and durable alternative to conventional synthetic casts in the conservative management of foot fractures. Their ability to maintain structural integrity even in non-compliant patients highlights their potential to reduce complications, improve patient comfort, and enhance overall orthopaedic care outcomes.
Keywords Foot fractures, Breathable mesh cast, Synthetic cast; Fiberglass cast, Conservative management, Heel breakage, Patient compliance, Below-knee cast, Fracture immobilization, Orthopaedic casting.
References
- 1. Ekwall A, Carlberg E, Palmberg G, Sloberg R. Complications of fiberglass cast. Int J Orthop Trauma Nurs. 2018;31:32–34. [Google Scholar]
- 2. McGraw-Heinrich JA, Wall JC, Rosenfeld SB. Common cast complications. J Pediatr Soc North Am. 2025;12:100244. [Google Scholar]
- 3. Mitchell BC, Baldwin K. Properties and pitfalls of various casting materials. J Pediatr Soc North Am. 2025;12:100234. [Google Scholar]
- 4. Szostakowski B, Smitham P, Khan WS. Plaster of Paris—history and practice. Open Orthop J. 2017;11:291–296. [Google Scholar]
- 5. Davids JR, Frick SL, Skewes E, Blackhurst DW. Skin pressure beneath cast materials. J Bone Joint Surg Am. 1997;79(4):565–569. [Google Scholar]
- 6. Hutchinson MJ, Hutchinson MR. Temperature beneath cast material. J Orthop Surg Res. 2008;3:10. [Google Scholar]
- 7. Pope MH, Callahan G, Lavalette RN. Setting temperatures of synthetic casts. J Bone Joint Surg Am. 1985;67(3):472–476. [Google Scholar]
- 8. Gannaway JK, Hunter JR. Thermal effects of casting materials. Clin Orthop Relat Res. 1983;(173):242–248. [Google Scholar]
- 9. Kaplan SS. Burns following plaster splints. J Bone Joint Surg Am. 1981;63(2):226–230. [Google Scholar]
- 10. Tomar L, Govil G. Fiberglass cast application in immediate post-operative period after ankle fracture surgery. Int J Res Orthop. 2024. [Google Scholar]