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1. Position patient in a comfortable position with knee extended. The foot and lower extremity is aligned with the sagittal plane.
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2. Palpate STJ Neutral Position: Grasp foot in area of 4/5 sulcus, palpate the talonavicular joint and locate the STJ neutral position by inverting and everting the foot.
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3. Lock MTJ: Suspend foot slightly, dorsiflex the ankle and apply slight abductory force on the forefoot to lock the midtarsal joint.
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B. Casting
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1. Apply dampened strip of plaster gauze working from the lateral aspect of the foot (area of 4/5 metetarsal heads), wrap plaster around the posterior aspect of foot to medial.
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2. With the back of your hand, smooth plaster from lateral to medial over the plantar aspect of foot ensuring smooth contact with entire surface.
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3. Ensure that the plaster bandage is not wrapped too tight around the foot causing hallux dorsiflexion and a reduction in gauze contact with arch (bow-stringing).
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4. Position in STJ neutral using dry piece of gauze bandage, grasp sulcus 4/5 and position the STJ neutral.
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5. Lock the midtarsus and smooth plaster with back of hand through arch and over the entire plantar aspect.
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6. Cast Evaluation: Inspect cast for casting errors and evaluate rearfoot to forefoot relationship to determine accuracy of cast to exam findings.
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