There are disclosed systems and methods of creating airflow through a breathable orthopedic cast. In an embodiment, a ventilation system includes a covering having an opening for creating airflow therethrough with an air moving device, and a scaffold structure disposed between the covering and the cast so as to maintain airflow a distance from the opening of the covering. In an embodiment, a ventilation method includes placing a spacer and a covering on the cast to enclose an outside portion of the cast, and creating airflow through the opening and the cast enclosed by the covering. Other embodiments are also disclosed.