Homegoing Instructions for Clubfoot Casting

Your child’s foot is being placed in a cast to begin to correct the turning of his/her foot and to prevent future deformity.

Treatment consists of gently massaging and manipulation of the clubfoot to stretch the contracted tissues.  A cast is then applied to maintain this correction.  After the foot has been in this position for approximately seven days, the muscles and ligaments will stretch enough to make further correction possible.  The cast is removed and the same process of gentile massaging and manipulation is repeated at one week intervals for approximately 6 weeks or until your doctor feels adequate correction has been achieved.

To help correct the deformity the Achilles tendon needs to be cut in about 80% of the babies before the application of the last plaster cast.  This procedure is called a tenotomy.  The tenotomy is done under local anesthesia with a very thin scalpel.  A few drops of blood usually stain the back of the cast to the size of a quarter.  The tendon will heal and reattach within 2-3 weeks.

After the cast application:

The first 24 hours after the cast is applied your baby may be restless but he/she should be comfortable after that time.  Please perform the following:

  1. Check the circulation in the foot every hour for the first 12 hours after the application, and then four times a day.  This is done by pinching the toes and watching the return flow of the blood to the area.  The toes will turn white and then quickly return to pink if the blood flow is good in the foot.  This is called blanching.  If the toes are dark, cold and do not blanch (white to pink), the cast may be too tight.  If this occurs call us at (970) 351-0900.
  2. The top of the toes should be exposed.  If you cannot see the toes, it may mean that the cast has slipped and correct reduction is not being maintained.
  3. Keep the cast clean and dry.  The cast may be wiped with a slightly dampened cloth if it becomes soiled.
  4. The wet cast should be placed on a pillow or a soft pad (hard surfaces may dent the wet plaster).  Whenever your child is on his/her back, place a pillow under the cast to elevate the leg so that the heel extends just beyond the pillow.  This prevents pressure on the heels which could cause a sore.
  5. Use disposable diapers and change the baby often to prevent to prevent cast soiling.  Apply the diaper above the top of the cast to prevent urine/stool from getting inside the cast.  Diapers with elasticized legs work well.

Notify your doctor if you notice any of the following:

  • Any drainage on the cast
  • Any foul smelling odor coming from inside the cast
  • If the skin at the edge of the cast becomes very red, sore or irritated
  • If your child runs a fever of 38.5 C/101.3 F or higher without and explainable reason, such as a cold or virus.

A new cast will be applied every 7 to 10 days.  Please remove the cast at home before coming into the office for your visit to be re-casted.  You will want to soak the cast in warm water and vinegar, and make sure that the water is getting inside the cast as well as on the outside.  The more vinegar that you add to the water the faster it will work on softening up the plaster.  Even with adding the vinegar you will still want to allow approximately ½ hour to soak the cast.  If your child is a newborn be aware of the water level in the sink/tub and be sure not to get the umbilical cord wet.  Once the cast is soft you can grab the end of the plaster and unroll it around the child’s leg, or remove the cast with utility scissors.  If you have any questions during the cast removal process do not hesitate to call the office at (970) 351-0900 for further advice and assistance.

Following removal of the last cast and in order to prevent relapse, the baby will be fit with a Dennis-Browne splint (shoes attached to a metal bar).  The splint will be worn 23 hours a day for 2 months, and thereafter, at night and during naps for an additional 2 to 4 years.  The first and second nights of wearing the splint the baby may be uncomfortable, but it is important that the splint is not removed.  After the second night the baby will adapt to the splint.  Relapse will almost invariably occur if the splint is not worn as prescribed.  When the splint is removed ordinary shoes can be worn.  Yearly visits will be scheduled for the next 3 to 4 years to check for possible relapses.