Signs That There May Be a Problem With Your Cast

Casts are an excellent treatment for broken bones. However, problems can arise when wearing a cast that may go unnoticed unless you spot the signs and report them to your healthcare provider. It is not just pain you should be concerned about but also signs of infection, excessive swelling, or improperly healing bones.

A properly fitted cast should fit comfortably for the duration of the treatment period. 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.

A doctor holding a child's broken ankle
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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, people are still generally encouraged to keep the cast dry.

The problem is not so much about a cast "falling apart" (although some can) as it is about soaking the skin underneath the cast. Doing so can lead to skin maceration in which your skin starts to break down on a cellular level.

Skin maceration can lead to increased itchiness as well as the development of sores and cracks. This, in turn, can lead to skin infections as bacteria and fungi thrive in moist, dark environments.

If you get water under your cast and it wasn't made to tolerate water, you should let your healthcare provider know as the cast may need to be replaced. Signs of infection warrant immediate care.

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.

In addition to pain, pressure sores can lead to a skin infection 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 seeps through.

If you suspect that you have a pressure sore under your cast, see your healthcare provider as the cast may need to be loosened or replaced.

Compartment Syndrome

A 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 places excessive pressure on nerves and blood vessels that not only triggers pain but also reduces blood flow to tissues.

If not recognized and treated appropriately, compartment syndrome can cause permanent nerve injury and even tissue necrosis (death).

Compartment syndrome is often recognized when the skin outside of the cast turns cold and bluish in color (referred to as cyanosis). This is due to the deprivation of oxygen in tissues.

When to Call Your Healthcare Provider

If you have any of the following symptoms, it could be a sign of a cast-related complication in need of immediate medical attention:

  • Pain or swelling that is not controlled with prescribed medications
  • Worsening numbness or tingling in the hands or feet
  • Inability to move your finger 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
  • High 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

Casts may be fun for a little while, but, for most 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.

Frequently Asked Questions

  • How do you sleep with a cast?

    To make yourself more comfortable, elevate the cast above your heart with pillows. Elevating the cast helps to reduce swelling and pain. You can use more pillows to prevent excessive movement of the affected limb.

  • How long does it take to heal a fracture?

    The healing time for fractures varies both by the bone and the type of fracture, but the average time is about six to eight weeks.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Library of Medicine. Closed reduction of a fractured bone - aftercare.

  2. American Family Physician. Principles of Casting and Splinting.

  3. National Library of Medicine. Pressure Sores.

  4. American Academy of Orthopaedic Surgeons. Compartment Syndrome.

  5. UpToDate. Clinical features and diagnosis of acute lower extremity ischemia.

  6. Cleveland Clinic. Bone fractures.