Tips, Tricks & Techniques

Tips, Tricks and Techniques for the Slipper Sock

  1. DON’T FORGET THE BAGGIE!!
  2. For 1st time users, use very cold water to activate the resin. This will provide more time to get used to handling the material before it hardens. Once you become familiar with the application process, use hot water to speed up the curing time.
  3. When applying the slipper clips, there is no need to touch the sock with either hand during this process. The following process is recommended: Grab the clips with both hands, pinching the clips between the thumb and index finger. Next, hook the elastic band on the medial side at the mid-arch level and lift it 1” upward from the foot. While holding the clip in this “pulled up” suspended position, with the opposite hand, stretch out the rubber tube and hook the clip onto the elastic band on the lateral side at the level of the cuboid. With both clips engaged securely into the elastic band, lower the clips to the foot surface and gently release them.
  4. Make sure to pull up the socks toward the malleoli and behind the heel after applying the slipper clips. This will ensure a deep heel cup and better cast.
  5. After the cast hardens and the clips are removed by “twisting them off”, grab the top of the baggie with both hands on the medial and lateral side and pull it up toward the knee with some force. This will break the “vacuum” created between the casting sock and the baggie at the plantar surface of the foot and facilitate removal of the cast.
  6. Remove the cast by initially pulling the cast downward behind the heel with both hands. Once it is below the plantar heel surface, pull the cast forward with your fingers engaged on the elastic band at the distal end of the cast opening
  7. Let the cast sit for at least an hour before shipping to let it fully harden.
  8. Do not package the casts too tightly to avoid being crushed during the shipping process.
  9. METHOD TO MARK LESION ON THE INSIDE OF THE CAST:
    1. Remove cast and baggie from foot using the method described above.
    2. With a scissors, cut the cast from the distal end of the opening to the distal end of the cast just past the colored stitch line. Make this longitudinal cut on the top of the cast (over the third toe area). Set the cast aside.
    3. Using paper tape, cover the lesion or area to be marked.
    4. Using a wet Sharpie or lipstick, make a thick/heavy mark or outline on the tape over the affected area.
    5. Immediately put the cast back onto the foot by expanding the opening with both hands and slipping the sock onto the foot. The sock will “spring back” to conform to the shape of the foot once in place.
    6. With the casting sock back in place, use your thumb to press the outside of the cast over the area previously marked to make an imprint of the Sharpie/lipstick on the inner surface of the cast.
    7. Remove the cast from the foot and examine marked area on the inside surface. If necessary augment the impression using a Sharpie/lipstick so the lab can recognize it more readily.

Tips, Tricks and Techniques for the Ankle, Midleg and Bermuda Socks

  1. DON’T FORGET THE BAGGIE!!!
  2. For 1st time users, use very cold water to activate the resin. This will provide more time to get used to handling the material before it hardens. Once you become familiar with the application process, use hot water to speed up the curing time.
  3. Put a paper towel over the front edge of the casting table/platform to avoid getting resin on the upholstery.
  4. Make sure the patient’s leg extends far enough over the front edge of the casting table or leg lifter to accommodate the length of the cast being applied so you don’t “run out of length” during the application process.
  5. Make sure foot is at a right angle to leg before applying plastic cutting strip. For those patients with an equinis, flex the knee to help with positioning.
  6. Once you have gotten used to removing the cast with the channel tube, you can eliminate this step t in the application process if you use the envelope slitter to remove the cast provided by STS. You should be totally familiar with the removal process before eliminating the tube to avoid injury.
  7. To allow more working time, especially for beginners, gather up the sock before dipping it in water, keeping the colored stitch line facing you during the gathering process. During the application process make sure you stretch out the wrinkles as you apply the sock up the foot and leg,–much like applying a compression sock—and avoid any overlapping or folds in the sock. Once you become familiar with the application process, you can dip it in water before the gathering process.
  8. Don’t forget to make a “cheater” hole in the sock just behind the base of the toes over the plastic cutting strip. Do this immediately after the sock is applied and before it begins to harden. We strongly suggest using the STS sock removal scissors as they are specifically designed for this process.
  9. Use plenty of water after the sock is applied either with wet gloves of a fine mist spray bottle. Unlike plaster, excess water will not weaken or dilute the cast. These casts can be applied in a swimming pool so don’t be afraid to saturate the casting surface with lots of water—the wetter the better.
  10. After the sock is stretched out and wet, rub the casting resin into the fabric by massaging the foot, heel, ankle, and leg on all sides. This ensures homogenous distribution of the resin and a smoother, more rigid cast.
  11. There is no need to hold the foot in the casting position during the entire casting process. Wait until the warming exothermic reaction begins to cool (and the resin stops bubbling) before positioning the foot. The cooling process takes about 2-3 minutes before the cast is ready for removal. During the exothermic warming you should continue to massage the cast as described above.
  12. If in doubt as to how to position the foot during the casting process, call the lab you will be sending the cast to for fabrication of the device.
  13. During the removal process, cut the sock from distal to proximal using the “cheater” hole previously made with the removal scissors. Cutting from distal to proximal, makes the “turn” in front of the ankle a lot easier.
  14. METHOD TO MARK LESION ON THE INSIDE OF THE CAST:
    1. Remove cast and baggie from foot using the method described above.
    2. With a scissors, cut the cast from the distal end of the opening cut to the distal end of the cast just past the colored stitch line. Make this longitudinal cut on the top of the cast (over the third toe area). Set the cast aside.
    3. Using paper tape, cover the lesion or area to be marked.
    4. Using a wet Sharpie or lipstick, make a thick/heavy mark or outline on the tape over the affected area.
    5. Immediately put the cast back onto the foot by expanding the opening with both hands and slipping the sock onto the foot. The sock will “spring back” to conform to the shape of the foot once in place.
    6. With the casting sock back in place, use your thumb to press the outside of the cast over the area previously marked to make an imprint of the Sharpie/lipstick on the inner surface of the cast.
    7. Remove the cast from the foot and examine marked area on the inside surface. If necessary augment the impression using a Sharpie/lipstick so the lab can recognize it more readily.
  15. Let the cast sit for at least an hour before shipping to let it fully harden.
  16. Do not package the cast too tightly to avoid being crushed during the shipping process.
  17. FOR PATIENTS WITH VERY LARGE OR EDEMATOUS LOWER EXTREMITIES TRY THIS :
    1. For those individuals with an elephantiasis type lower extremity it may be difficult to get the sock up over the calf because of the girth of the leg. We recommend that you make a 2”-3”cut on the top front margin of the sock to allow it to “open up”. With an assistant helping, pull the sock up after the cut is made (the cut may have to be extended) and have the assistant keep the sock pulled up while you mold the impression. When the sock hardens a “V” will be created in the top front where the cut was made. Cover this space with two or three strips of plaster. The plaster will adhere well to the hardened surface of the cast. When the plaster hardens, carefully cut through the plaster with scissors or a cast cutter over the cutting strip. You can then cut through the hardened cast in the usual manner from distal to proximal.