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.
What to expect during casting:
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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.
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This takes place within the first few weeks of the baby being born.
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The cast extends from groin to toe.
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Casting varies from approximately 4-8 weeks.
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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.
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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.
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Two team members will apply the cast: one will manipulate the foot and the other will apply the cast.
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Only the affected foot is stretched and casted. Bilateral cases will have both feet casted at the same appointment.
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Parents are present at this time.
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The cast will hold the correction maintained by the manipulation.
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Gradually, bones and joints are brought into correct alignment.
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This may be slightly uncomfortable for the baby, but the baby is not in pain.
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At the weekly appointment, the old cast will be removed and the new one applied.
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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.
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It is important to not remove the cast before your appointment, as some regression may take place.

What to bring to the appointment:
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Supplies for breastfeeding or bottle feeding
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A pacifier or comfort object
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You can ask about using sugar water on a binky to help soothe the baby
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Bath supplies like a washcloth are helpful for cleaning between casts
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:
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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!)
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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.
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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.
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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.
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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.
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Baby-wearing: Check out our baby-wearing page for more information.






If your child's cast is removed with a cast saw, earphones may help the child not be frightened.
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.
Difficulties adjusting to casts:
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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.
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Monitor cast for any odor.
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If the cast rubs at the top of the thigh, you can use Moleskin and/or a leg warmer or long sock.
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Ask yourself if your child is uncomfortable or in pain
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The toes should be visible.
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If the cast slips off or slips down, call your doctor ASAP.
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Try having baby sleep in a swing, bouncer, Rock and Play, etc.
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Roll up a blanket or towel and place under the cast.
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Place a Boppy pillow under the cast to elevate and support the legs
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Tylenol or motrin may help (discuss with your doctor before administering any medication to infant/child.)
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Gas is very common in clubfoot children, so rubbing their tummies or giving them gas drops should help with this.
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If the top of the cast is rubbing the skin, put some moleskin on it. Also, the leg warmers should help with this
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Some have found that an Amber Necklace helps or a white noise machine

When to call the doctor:
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Cast has an odor and/or there is drainage from cast.
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Skin appears irritated, red, or sores have developed.
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Cast is slipping down or has fallen off.
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If your baby is continuously crying, or has a fever.
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Has dark and cold toes (blanching of the toes does not occur).
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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:
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Never put anything in the cast.
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Discuss pain management for your child with the child’s doctor.
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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.

*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.