Signs That There May Be a Problem With Your Cast

Casts are often an important part of the management of broken bones. However, problems can arise when wearing a cast. These issues may go unnoticed and worsen 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 an improperly fitted cast that may affect bone healing.

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
ER Productions / Blend Images / Getty Images

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.

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.

5 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. Cleveland Clinic. Bone fractures.

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.