We use casting to correct the feet. Before casting begins, your child should be healthy and gaining weight. Breastfeeding should be well established. Typically, we start casting when your child is around 2 to 3 weeks old. If this needs to be delayed because of other issues, don’t worry. Most children have good results no matter when casting is started.
Timeframe for casting:
Step 1: Long leg casts are applied when your child is around 2 weeks old.
Step 2: These casts are changed every week for four to 10 weeks.
Step 3: The heel cord is cut and a final cast is placed for three to four more weeks.
Step 4: After this last cast is removed, your child is fitted for a foot-abduction-brace, which is worn full time for at least three months.
How is the casting performed?
First, the foot is gently stretched and a cast is applied to hold the foot in the stretched position. More plaster is added to the upper leg to make the cast a long leg cast that goes from the toes to the upper thigh. This helps keep the cast in place.
Every week, the cast is removed, the foot is stretched, and a new cast is applied. For older children, the casts are usually changed every two weeks.
Casting is not easy in infants and small children. Ideally, children should be relaxed and calm. Feeding them with a bottle helps, so breastfed infants should be given a bottle on a daily basis once breastfeeding is established. Not feeding children right before leaving home also makes it more likely they will be hungry and take a bottle during casting.
Your child may appear uncomfortable during the procedure, but the casting itself is not painful. Children may be unhappy since they are not able to move their legs, and the longer your child is in the casts, the more sensitive their feet become. You will notice that they will actually become calmer once the lower portion of the cast is put on.
For older children, bring along some toys (make sure they have something they can play with while lying on their back). Giving them something to eat and drink while you are waiting may also keep them from getting fussy before we start casting.
Follow-Up after Casting
Your child will be seen every one to two months during this time.
If the foot / feet remain fully corrected, your child will continue with a brace, primarily at night, until they are at least 4 years old. Over this time, you will see the doctor every three to six months.
- Wearing the bar and shoes as instructed is essential to reduce the chance that the clubfoot will recur. If the clubfoot recurs, we will try to correct it with casting.
- Many children require some surgery to obtain the best correction, but repeated or more severe recurrences often require bigger surgeries.
Potential Problems with Casting
Casting is a gentle and safe method of correction, but casts that are too tight or that become loose can cause problems.
- Call the clinic and talk with the orthopaedic resident on-call if your child:
- Is fussy for more than 36 hours after the cast is placed. It may be too tight or too loose.
- Go to the closest Emergency Room to have the cast removed for any of the following. Be sure to tell whoever removes the cast that it is thin and there is very little padding. You do not want your child to be cut or nicked when the casts are removed.
- Toes on cast foot become white or purple. This means the cast is too tight.
- Toes that sink back into the cast and you are unable to see them. Sores might develop.
Call our clinic first thing in the morning to schedule a time to replace the cast.
- If you have concerns about your child’s cast, go the Emergency Room to have the cast removed – it is always easier to put on a new cast than fix a more serious problem.
Cast Care and Daily Concerns
- Check the circulation in the foot every hour for the first 12 hours after new cast application. After that, check it four times a day – morning, noon, dinner and bedtime. To check the circulation:
- Pinch the toes and watch the return flow of blood. The toe will turn white and then quickly return to pink if the blood flow is good to the foot.
- Compare this with the other foot if it seems delayed to you.
- If toes are dark and cold, or are very white, the cast may be too tight. If this occurs, have the cast checked at the Orthopaedic Cast Clinic or by the local doctor or emergency room immediately. Call our clinic to talk to the orthopaedic nurse or the orthopaedic resident on-call to find out what to do.
- Make sure you can always see the toes on the casted foot. If you cannot see the toes, it may mean the cast has slipped and correct reduction is not being maintained.
- Call the Orthopaedic Clinic immediately so we can change the cast.
- Keep the cast clean and dry. You can wipe the cast with a slightly dampened cloth if it becomes soiled.
- Place the cast on a soft surface for the first 24 hours − it takes this long for the cast to completely dry. This prevents pressure on the heel, which could cause a sore.
- Change diapers often to prevent cast soiling. Apply the diaper above the top of the cast to prevent urine from getting inside the cast. Disposable diapers with elasticized legs works the best, but cloth diapers work fine if watched closely and changed as soon as they become wet.