High-Performance Activity With Below-Knee Cast Treatment, Part II: Clinical Application and The Weak Link Hypothesis.

: High-performance casting methods offer a different approach to treating a variety of ailments. Because this approach has excellent patient acceptance, it can be used when more aggressive treatments are undesirable or refused. Observations made during six years of experience with high-performance casting and orthotic management are divided into clinically related groups. These clinical groupings cross conventional diagnostic boundaries. Success depends upon careful patient selection, which, in turn, requires both a detailed history and the seeking of subtle physical signs. The practical details of high-performance cast application are described for each group. Although specific cases so treated have had spectacular results, many of the clinical groupings remain hypothetical, in recognition of the need for a wider experience over a longer span of time. If a casting technique that leaves the patient fully functional is available, treatment methods for a variety of ailments can be reconsidered. In so treating patients with orthotics and casts over the last six years, the author has made a series of observations that have evolved into a rather simple and unifying theory that may prove useful to the clinician.