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Clubfoot initial treatment phase

Clubfoot initial treatment phase

Ponseti method and casting

The Ponseti method involves gradually correcting the position of the child’s foot by doing serial cast changes. During manipulation by the physician, the muscles, tendons and ligaments are stretched so that the forefoot gradually turns in external rotation and the talus (very prominent at birth) resumes its position. Full correction may require five to seven casts, which are generally changed every week. Correction by casting is completed once the foot is overcorrected in external rotation (turned outward). At this stage, the foot is still pointed downward. This occurs in 90% of feet, and to correct this the second phase of the treatment is required: one minimal surgery.

How are casts applied?

Casts are applied in two stages: the first is a short-leg cast (just below the knee) which the physician applies to correct the foot. The nurse takes care of the second type (long-leg cast) by extending the cast to the upper thigh in order to position the tibia in external rotation. Also, by extending the cast to the thigh, children cannot get out of their casts.

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What to watch for after the cast is applied

  1. Do not wet the cast
    As casts are made of cotton and plaster of Paris, they cannot be allowed to get wet. You must use the sponge bath technique to maintain your child’s hygiene; this is why we offer to bathe your child once a week when the cast is changed. If the cast gets wet between two appointments, contact the cast room nurses so that it can be changed as quickly as possible, and try to dry the cast at home. As baby skin is very delicate, DO NOT USE A HAIR DRYER, you might burn him. If the cast accidentally becomes completely submerged in water, let it soak for 30 minutes so that you can remove it yourself at home. A cast that is completely saturated for several hours could result in skin maceration. We will have to replace the cast as quickly as possible so as to not lose the ongoing foot correction.
  2. Neurovascular signs
    It is imperative to check for any neurovascular signs after a cast is put on. One way to ensure that the cast is not too tight and there is good blood circulation in your child’s leg is to verify the colour of the toes (pinkish), the skin is warm, and capillary refill is normal (the toes turn white when you press on them then return to pink in less than three seconds). If your child’s toes are blue, purple or white, and do not seem to return to pink after having warmed them up, remove the cast by soaking it in water for 20 to 30 minutes. You will then be able to unravel it. Immediately contact the cast room nurse so we can replace the cast as quickly as possible, preventing any loss of correction.
  3. Initial cast position
    Always verify that the cast has not moved and remains in its initial position. If you see that your child’s toes are no longer exposed at the bottom of the cast and they seem to turn inwards, the cast will have to be removed. Contact the cast room so that the cast can be quickly redone. Poor foot positioning within the cast may cause pressure ulcers and make your child very uncomfortable.

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Ponseti method and treatment phases continued