The initial cast may need to be replaced during the treatment period, as it’s common for a common for the case to become loose as the initial swelling begins to come down. There may be some itching and aches as the bone starts to heal, but new or worsening pain is a sign that something is wrong.
This article looks at some of the potentially serious problems that can occur while wearing a cast. It also lists the signs and symptoms that warrant an immediate visit to your healthcare provider.
Skin Maceration
One of the most challenging aspects of having a cast is keeping it dry. While there are waterproof casts and cast materials made to tolerate moisture, most people are still encouraged to keep the cast dry.
Some casts can become damaged by water, but the more serious problem is the potential for skin maceration, which is when the skin starts to break down. Water that’s trapped in your cast can lead to skin damage.
Skin maceration can cause itchiness as well as the development of sores and cracks. This, in turn, can lead to skin infections.
If you get water under your cast and it wasn’t made to tolerate water, you should let your healthcare provider know—because the cast may need to be replaced.
Signs of infection warrant immediate care. These include a fever, soreness, pain, redness, skin warmth, a foul smell, or pus underneath the cast or extending beyond it.
Pressure Sores
Another complication of wearing a cast is pressure sores, also known as pressure ulcers. These tend to develop over bony areas, such as the ankle or elbow. They are caused by sustained pressure on the skin, often when a cast is poorly fitted.
Pressure sores may cause pain, and can lead to skin infections and bleeding. Skin infections can often be recognized by a foul odor and/or the drainage of fluid from underneath the cast. There may also be a visible spot on the cast as the drainage or bleeding seeps through.
If you suspect that you have a pressure sore under your cast, see your healthcare provider. The cast may need to be loosened or replaced.
Compartment Syndrome
A rare but more serious cast-related complication is compartment syndrome. This occurs when a cast is too tight, causing pressure within the cast that cannot be released. This may compress nerves and blood vessels and can reduce blood flow to tissues.
Symptoms of compartment syndrome are:
Increased and uncontrolled pain Severe pain when passively moving the fingers or toes Increasing numbness or cold Bluish skin discoloration (referred to as cyanosis) due to the deprivation of oxygen in tissues.
If not recognized and treated appropriately, compartment syndrome can cause permanent nerve injury and tissue necrosis (death).
When to Call Your Healthcare Provider
If you have any of the following symptoms, it could be a sign of a cast-related complication that needs immediate medical attention:
Pain that is increasing, severe, and not controlled with pain medications or improved by elevating the injured limb to heart level Swelling Worsening numbness or tingling in the hands or feet Inability to move your fingers or toes Bluish discoloration of the hands or feet Skin that remains white after pressing down on it Foul odors from beneath the cast Drainage of fluids from beneath the cast Fever with chills Loosening, splitting, or broken casts
Summary
Casts aid in the healing of bones but may cause problems if the cast gets overly soaked or is improperly fitted. This can lead to skin maceration (in which saturated skin starts to break down), pressure sores (typically on bony parts of the body), and compartment syndrome (caused when a tight cast cuts off blood circulation).
If left untreated, these complications can lead to skin infections, permanent nerve injury, and even tissue death. They can be avoided by replacing the cast if it gets damaged or is too tight.
A Word From Verywell
You can have fun with your cast, but, for many people, they eventually become extremely annoying and even unbearable. No matter how annoying they become, never attempt to remove a cast on your own. This is true even if a cast is scheduled to be removed.
Orthopedists remove casts with saws specially designed to avoid harming underlying tissues. Attempting to remove a cast with other tools can be dangerous and cause serious injury. If you feel that your cast needs to be removed for any reason, call your healthcare provider.
