If numbness or tingling occurs in a limb covered by a cast, which finding would be most concerning and require prompt assessment?

• A. Inability to move the toes
• B. Tingling sensation in the foot
• C. Pedal pulse of 90 beats per minute
• D. Fiberglass cast that is damp after 4 hours

Answer: (B)

When a limb is in a cast, watching for neurovascular changes is crucial because swelling inside the cast can compress nerves and blood vessels. A new tingling sensation in the foot signals nerve irritation or compression and is an urgent cue to assess promptly to prevent progression to loss of sensation, motor function, or tissue ischemia. The clinician should perform a quick neurovascular check distal to the cast, consider loosening or removing the cast if allowed, elevate the limb, and notify the physician for further management. In comparison, a normal pedal pulse is reassuring, a damp cast is more about skin care than an immediate nerve issue, and an inability to move toes suggests a more advanced deficit but isn’t as immediate a warning as new tingling.