Cast Covers Review
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BioMechanics Desk Reference: Cast Covers
February 1996, Volume III, Number 2
Baggies vs. Cast Covers
by Edwin Black
Just as your patient is hobbling out of the office burdened with a plaster cast or a wound dressing, he suddenly asks: "What about a bath or shower?" Right about then the nurse will suggest any of several inexpensive cast bags that can be obtained from drug stores or occasionally dispensed in the practitioner's office. But some offices cavalierly recommend a plastic trash bag and a rubber band.
Invariably the patient looks with confusion and doubt at the contraptions, which range from overgrown socks with tubes coming out of them to giant versions of Ziploc sandwich bags. But do any of these work, and what do the professions think about them?
BioMechanics unscientifically spot checked a half dozen leading podiatrists, orthopedic surgeons, athletic trainers, and physical therapists and found a wide range of beliefs and practices about cast covers -- pro, con, and indifferent.
Eric Lauf, DPM, who practices in Falls Church, Virginia, preaches temporary abstinence: "Following surgery, until the skin has completely healed, any water whatsoever can be a conduit for infection. I almost never allow my patients to shower during the first two weeks. This frustrates some patients, but I would rather be their friend for life than their buddy for a week or two and then have them end up with an infection and hate me.
"With the wound healed, I will usually permit the patient to shower wearing a commercial device. But the patient must agree to contact me immediately should the foot become wet and need the dressing replaced."
Dr. Lauf recommends commercial covers as opposed to baggies "because the bags are simply too sloppy. Patients can trip on them. Cast covers are neater."
Dr. Lauf has no favorites. His decision depends in large part on the patient's size and build.
Steven Shapiro, MD, an orthopedist who practices in Savannah, Georgia, confirms, "I routinely recommend cast covers after foot and ankle surgery or injuries. "You can always tell patients to use a garbage bag with two rubber bands. That works for some, but sometimes they rip. I think orthopedists who are not using commercial covers should take a look at them."
But BioMechanics spoke to other practitioners wholly unimpressed with cast covers. Philip Organ, DPM, who practices in Fishkill, New York, insists, "None of the commercially available products work. They don't seal enough at the top to prevent leakage. I'm comfortable using plastic baggies to keep wound dressings from getting wet.
"For plaster casts," Dr. Organ adds, "I suggest the patient sit on a plastic stool while showering, keep the casted leg out of the tub, and use a hose attachment to shower, directing water away from the affected leg." Another two dozen practitioners would undoubtedly elicit another two dozen opinions. Cast covers are just one of those afterthoughts that clearly isn't forefront in the minds of many practitioners. But for patients who must tolerate the malodor of wet casts or dressings, or become a contortionist to bathe during treatment, keeping their lower extremity dry can be very important.
The reality is, practitioners will never know the efficacy of any commercially or home-rigged cast cover until they use them personally. Here are some insights:
There are about a dozen leading brands on the market. Each has its own quirky design and efficacy.
Trademark Medical's product is inexpensive and the most available, being widely distributed through retail channels. Construction is simple and low-tech. A rubber strap stretches across the crown to fasteners to create what is at best a loose seal. But it leaks easily and isn't recommended for any but the briefest moments of wet protection.
Another top sealer is the translucent Overcast bag which is formed to resemble a foot. It keeps most water out, but like others, the seal is far from perfect. Because of its shape, the Overcast is geared to practices concentrated in the foot and ankle.
More suited for practices that cover the entire lower extremity is Show'rbag, manufactured by Margue Co. Show'rbag's thick plastic bag is tall enough to encompass a leg from the foot to the thigh. It seals with a Velcro attaching top strap. It may be a bit awkward for short casts. But for practices which must treat every part of the lower extremity from hip to toe, Show'rbag is the only one with real reach.
A more engineered bag and a favorite is the impressive foot styled Seal-Tight by Brown Medical. Seal Tight is essentially a plastic ring atop a vinyl enclosure. Stretched across the diameter of the ring is medical grade rubber with a small opening for the leg to be inserted. The stretching rubber forms a seal that is quite effective in barring wetness. Navigating in and out of the tight seal can be eased with Vaseline.
The most unusual cast protector of them all is undoubtedly both the best and, at about $20, the most expensive. The sock-shaped XeroSox, by George Medical, is tacky on the underside to inhibit skids. Strangely enough, the patient must create a water-proof vacuum by sucking on a thick plastic tube attached to the sock--like he would a soda straw. The vacuum process is undone by a tug of the leg portal.
In choosing between a plastic bag and a commercial product there seems to be little contest. Baggies and rubber bands last only so many minutes before they spring leaks. Clearly, if you're going to seek a drier approach, you'll need a commercial cast cover. In judging efficacy, remember that patients often have a false sense of dryness while bathing because they can't detect seepage until long after they leave the tub. Droplets can gather at the heel and moisture can't be felt until the toes become wet.
Baggies and lawn bags cost next to nothing. But they accomplish next to nothing. A treatment protocol requires more than a haphazard home solution--it requires a well-engineered commercially fabricated cast cover. If you're really interested in protecting your patient's extremity, you'll investigate cast covers for yourself and see which, if any, are all wet.
Edwin Black is Publisher and Editor-in-Chief of BioMechanics Magazine.