Step 1:

Cast the patient

Apply 2 layers of 6” soft roll with each layer overlapping by 1/2 the diameter or 3”. Make sure that any bony prominences and the heel are well padded.
Using 6” fibreglass cast material apply from the proximal interphalangeal joints to the tibial tuberosity.
Overlap the cast material by 1/2 the diameter or 3”. Ensure the lower extremity is in a neutral position with no dorsiflexion / plantar flexion or inversion / eversion.
Step 2:

Assemble the stirrup

Set the height of the device so that the distal aspect sits near the widest portion of the gastrocnemius when the device has approximately 2.5”-3” of clearance below the calcaneus.
Set the width of the device so that the stirrup sits comfortably over the cast.
It is ok for the Alger Unloader to be slightly wider than the cast as the next layer of cast roll will compress both sets of proximal tabs to the cast.
Step 3:

Apply the stirrup

Apply one layer of 6” soft roll around proximal tabs and upper stays of The Alger Unloader.
Make sure the stirrup is at a neutral axis in the sagittal and frontal plane. The stirrup should be aligned to the longitudinal axis of a lower extremity.
Ensure that the stirrup sits approximately 2.5” – 3” below the plantar surface of the fibreglass cast.
Place two layers of 6” fibreglass cast material around the proximal tabs of the stirrup in order to secure it in place.
Allow the fibreglass to dry completely prior to commencing weight-bearing.
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