Casting

The early stages of treatment are part of a process that requires commitment by both families and your Orthopaedic Care Support Team.  This will help to achieve and maintain optimum results. 

*Disclaimer*

The information compiled is from clubfoot family experiences, and the medical community. Doctors and those in the medical field have opinions that may differ. This document is not a substitute for professional medical advice. Consult your doctor with questions. Every clubfoot situation and every clubfoot child's treatment plan may differ slightly.

Difficulties adjusting to casts:

  • Make sure toes are a pink color. To check circulation, press on the toes, they will turn white and then immediately turn to pink again. This is called blanching. 

  • Monitor cast for any odor. 

  • If the cast rubs at the top of the thigh, you can use Moleskin and/or a leg warmer or long sock. 

  • Ask yourself if your child is uncomfortable or in pain

  • The toes should be visible. 

  • If the cast slips off or slips down, call your doctor ASAP.

  • Try having baby sleep in a swing, bouncer, Rock and Play, etc.

  • Roll up a blanket or towel and place under the cast.

  • Place a Boppy pillow under the cast to elevate and support the legs

  • Tylenol or motrin may help (discuss with your doctor before administering any medication to infant/child.)

  • Gas is very common in clubfoot children, so rubbing their tummies or giving them gas drops should help with this.

  • If the top of the cast is rubbing the skin, put some moleskin on it. Also, the leg warmers should help with this

  • Some have found that an Amber Necklace helps or a white noise machine

Improper casting:

This document does not take the place of professional medical advice. Improper casting can compromise treatment. A typical clubfoot can turn in to an “atypical/complex” clubfoot with improper casting. Please see our pages regarding red flags and “atypical/complex” clubfoot for more information

When you get home:

  • Baths: Keep the cast clean and dry. You will give your baby a sponge bath. Wrap the cast in a towel to keep it dry during bath time. Use a cloth and wash baby. If water gets in the casts, use a blow dryer on the cool setting and call your doc. The “Summer Infant Delux Baby Bather” is a cast-friendly bather. Cover the cast in a long sock or leg warmer (this will also help to keep the cast clean!)

  • Sleeping:  Roll up a towel or small pillow and put under the cast. This will help to support the feet and legs and to make your baby comfortable. Many find a “Rock and Play” or swing helps the baby to sleep.

  • Diapers: Change diapers often to make sure nothing leaks on the cast. You can use a diaper cover over the diaper. Use a wet wipe to clean the cast. The top of the cast should be outside your baby’s diaper.

  • Clothing:  Many use short or long-sleeved onesies.  Wide-legged pants, stretchy pants, loose fitting leggings, and elastic waistband pants will work. Leg warmers or a long sock will protect the cast from diaper leakage. Footed pajamas will work(you may need one size bigger), and regular swaddles will also work.  

  • Breastfeeding:  You can breastfeed your child in a cast. Cover the cast with a leg warmer or long sock. This will help comfort you and your baby. Using a breastfeeding pillow also helps. Check out our breastfeeding page for more information.

What to bring to the appointment:

  • Supplies for breastfeeding or bottle feeding

  • A pacifier or comfort object

  • You can ask about using sugar water on a binky to help soothe the baby

  • Bath supplies like a washcloth are helpful for cleaning between casts

What to expect during casting:

  • Gentle manipulation is used to align the foot in a normal position with weekly casting to allow the soft bones to set. Here, the ligaments and tendons are gently stretched.

  • This takes place within the first few weeks of the baby being born.

  • The cast extends from groin to toe.   

  • Casting varies from approximately 4-8 weeks.

  • Typically, treatment begins during the first few weeks of a baby being born.  This is a time to take advantage of the tissues that have more elasticity. 

  • At each weekly visit, the baby’s foot will be manipulated to stretch the ligaments and tendons of the ankle and foot that are short and tight.  The foot is held in a progression of corrected positions by the cast. 

  • Two team members will apply the cast: one will manipulate the foot and the other will apply the cast. 

  • Only the affected foot is stretched and casted. Bilateral cases will have both feet casted at the same appointment.

  • Parents are present at this time. 

  • The cast will hold the correction maintained by the manipulation. 

  • Gradually, bones and joints are brought into correct alignment. 

  • This may be slightly uncomfortable for the baby, but the baby is not in pain. 

  • At the weekly appointment, the old cast will be removed and the new one applied. 

  • Plaster casts are the best material for making Ponseti casts. Some doctors will use soft-roll fiberglass, but we do not suggest this as it is more difficult to feel the positioning of the foot during the application process.

  • It is important to not remove the cast before your appointment, as some regression may take place.

When to call the doctor: 

  • Cast has an odor and/or there is drainage from cast. 

  • Skin appears irritated, red, or sores have developed.

  • Cast is slipping down or has fallen off.

  • If your baby is continuously crying, or has a fever. 

  • Has dark and cold toes (blanching of the toes does not occur).

  • If you end up in the ER for cast concerns, it isn't recommended that those in the ER re-cast your child.  

 

Important Reminders: 

  • Never put anything in the cast.

  • Discuss pain management for your child with the child’s doctor.

  • The cast will not interfere with your child’s scheduled immunizations (most doctors will do injections in the buttocks). If they do in leg above cast, monitor for potential swelling.   

You can still swaddle while in casts, and an embe 2 way swaddle is a great choice.  YOu have a legs in or legs out option.

If your child's cast is removed with a cast saw, earphones may help the child not be frightened.

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