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:

  • 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.

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

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.

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:

  • 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

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.   

*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.

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