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With an assistant:

The assistant stands on the medial side of the injured leg and maintains some flexion of the knee and the right angle position of the ankle, pressing gently on the knee and holding the big toe forwards in line with the patella.

This usually holds the reduction that has been achieved and allows the operator to apply the padding and the plaster cast.

Tip: Avoid strong dorsiflexion of the foot as this can cause posterior displacement of the talus, as previously discussed.


Without an assistant:

Apply the plaster padding.

Then, apply around the ankle one roll of POP (dipped in cold water to give more time until hardening), reduce the fracture and maintain it reduced until the POP skim is hard enough to hold the reduction.

Then complete the below-knee portion of the cast.