Casting FAQ

Most children are not bothered by casting or are easily distracted. Some doctors recommend breastfeeding or bottle feeding your baby during casting, you can also try a sound machine or a toy that they are interested in playing with.

Try to dry the cast the best you can and contact your doctor. If the soiling is minimal, try to clean it with a wipe and dry with a towel. If the cast is very wet it will need to be removed to prevent skin break down. Wearing leg warmers over the cast or adding Coban to the top of the cast can be a protective layer to help prevent any soiling or wetness.

It is best to give your baby a bed bath by cleaning your baby with a wet cloth on the change table or other surface.. Do not submerge the baby in water to prevent the cast from getting wet. Some parents will buy cleansing wipes to clean the baby’s body from the waist up, and then wash the baby’s hair over a sink with a small squirt bottle and some mild shampoo. You can cover your baby’s casts with a towel to prevent any misplaced water from landing on the casts.

Comfort your child the same way you would previously, with lots of cuddles, rocking, bouncing, singing, and nursing. Many parents feel scared that they will not be able to hold their baby in the same way they did prior to casts, but rest assured that there will still be plenty of ability to snuggle and cuddle in the same way. Your baby is likely more upset with the casts than in pain. If your child is inconsolable your child may not be properly casted and you should contact your healthcare provider.

Yes, you can use a carrier. You want to make sure that it has a wide seat base to support the legs and casts. Carriers are recommended to be designed in M sitting.

If your baby’s cast slips it can be really hard to determine exactly what to do. You should contact your doctor immediately, but sometimes they are not immediately available and you need to make a decision about whether to remove the cast or not. If you think the cast has slipped, you should remove the cast to prevent damage to the foot. It is important to remember that another cast can always be placed, and if you baby loses a bit of correction, that can be achieved with the placement of another cast. If the slipped cast is left on, it can cause damage that is very difficult to correct. If you are unable to get direct guidance from your doctor, trust your instincts, and if you think the cast has slipped, remove it.

Yes, your baby’s casts should not impact their ability to do tummy time. Many children do not enjoy tummy time. Consider laying your baby on your chest, so he can see your face, start on an incline and overtime lie closer to flat on your back. Remember to help your baby by propping him up on his arms or even putting a rolled up towel under his chest to help elevate his upper body. Remember that babies who cannot roll over by themselves should not be left unattended on their stomachs.

A regular car seat will work. You may want to look for one with a longer buckle, as it will be easier to do up. It’s not recommended to leave the boots and bar done up while in the car seat.

If you are outside you can keep their feet warm by placing large socks over the casts and there are some places that sell boot covers. You can also use leg warmers and pull them down further over the toes, or place a blanket over the toes when the baby is in the carseat.

In warm weather environments, simple onesies with crotch snaps work well as the casts do not need to be covered. In cooler environments, pants with full leg snaps work well or stretchy pants that are removed easily. Footed sleepers can be used when in casts, but you may need to go one size up.

No, it is unlikely that your child will be too hot in their casts alone. Dress your child following regular recommendations for weather and nighttime wear.

It is unlikely the casts will cause your child to experience difficulties with temperatures if dressed appropriately on top. You can simply wear a onesie and the casts in warmer weather.

If the casts get wet inside, they will need to be removed as it can lead to skin irritations. Please contact your healthcare provider for recommendations on what to do in this situation.

It is best practice to remove the casts at the time of the appointment.

Both types of casts are effective at treating clubfeet when properly applied. Plaster may have better results in complex cases. Fibreglass has good success and is easier to apply and remove. Every surgeon will have a preferred material with which they work.

Unless directed by the doctor, do not apply anything to the skin prior to casting. This may cause irritation or effect how well the cast sets, leading to slippage.

After casts are applied it is a good idea to mark on the toes where the casts end and/or take pictures from the top of the foot so you have a comparison, as a good reference point to look back at if you think the cast may have slipped. If the toes slip into the cast beyond your mark, the cast may be slipping. Remove the cast and contact your healthcare provider.

Lay the baby down or hold him in a lying position so that his legs are higher than his body. This helps drain the blood from his legs and reduce swelling. Try not to have your baby with legs hanging down for long periods of time. If the color does not improve, contact your doctor for further direction.

Try to get into the habit of checking your baby’s cast placement multiple times a day. Create a routine that is easy to follow. For example, check the placement every time you do a diaper change.

No, the cast should be above the knee to hold proper placement.

Yes, this is normal. Feet can correct at different speeds as they can be different in severity.

Best practice is to remove casts at the appointment to recast shortly after. Casts should only be removed at home in case of emergency or slippage. Fiberglass casts are unrolled while plaster casts are soaked or cut off.

If you have access to “Coban” from the pharmacy, you can wrap it to provide extra padding by tucking it over the edge. Other materials like cotton can be wrapped and tucked over the edge to provide padding. Do not push padding into the cast. If the cast seems excessively loose contact your doctor as you may need it realigned.

The Ponseti Method is a proven technique to correct clubfoot with serial casting and possible tenotomy. After the correction casting phase, the maintenance phase is the most important task in order to maintain correction.

Check to see that your child’s feet have good circulation. You can do this by squeezing a toe slightly until it turns white and then count the seconds for it to return to normal colour. It should be less than three seconds. Make sure the casts have not slipped and are still in the correct position. Some infants become uncomfortable because they can not pass gas as easily, due to the inability to kick legs. You can move the baby’s legs for them to assist and practice regular knee to chest movements.

Casting should never be painful. Some children experience mild discomfort because of the stretching, or annoyance or frustration from not being able to move their legs.

You may cover with loose fitting clothing but be careful to not tug or pull the casts which may cause slipping. It is not necessary to cover the cast.

Diapers, cloth or disposable, should be used while in casts as much as possible to avoid getting body fluids on the casts. The casts cannot be washed or get wet.

Your baby will need the same love and care they received before. They can continue to participate in many regular routines, with the exception of baths which will need to be done using a washcloth. Play with, cuddle and soothe them as you normally would. You will also want to check the cast position (slipped casts) and ensure that the casts stay dry between appointments.

The number of casts depends on the severity of the feet and how well your child is responding to treatment. A typical case of clubfoot usually requires five to seven casts, if more than seven are required, consider a second opinion.

Each cast is typically changed every 7 days. There are doctors who do accelerating casting which have shorter time frames between each cast. Your doctor will let you know how long between each cast.

It is best to remove the casts at the hospital prior to the next casting. This decreases the chance of any delay between casts.

Educating family and friends about clubfeet is the best way to reduce stigma. Be confident it was not caused by any error on your part as parents, and that your baby is happy and healthy otherwise. Most people assume there is an injury when they see casts. It is up to you to explain that there is a birth deformity being corrected with the casts.

It is important to figure out what is causing the rash. The most likely cause would be rubbing or friction on the thighs or groin. Consider applying a barrier to help prevent the rubbing such as a bandaid or sock over the area. inform your doctor of any rashes as the cast may need to be applied differently.

If a rash occurs in other areas seek medical advice.

A child falling is always a danger. Casts do not pose any greater risk to the child.

When changing, be careful when lifting your baby’s legs. Pulling on the legs/casts may cause slipping. Consider lifting from underneath their back/buttocks or roll them onto their side slightly, rather than pulling up from their feet.

It is recommended that all babies sleep on their back until they can roll over by themselves. You can provide extra support by placing a rolled up towel under their legs to provide support under their knees.

It is ok if the baby lifts its legs while in casts. Movement should be encouraged as it helps the baby feel more comfortable and can relieve gas.

If water enters the casts, they must be removed. It is best not to bathe the baby in water but rather wash the baby with a wet cloth, by giving a bed bath.

Comfort your baby as they are now adjusting to the decreased mobility from the casts. Many babies will need extra holding and nursing to feel comforted. Some babies may be extra gassy at night so practice moving their legs throughout the day to prevent gas build up at night. Try providing support under their legs when sleeping by rolling up a small towel and placing it under their knees.

There are several red flags that parents can look during casting including:

• Slipped casts
• Skin Issues
• Blanching of the toes
• Suggested break between casts
• Foul smelling odour coming from cast
• Temperature of 101.3 or above
• A suggested break between final cast removal and beginning BNB

Babies usually begin treatment shortly after birth. Some doctors prefer the baby be a certain weight before casting begins. You can determine the exact timing if you have a consultation with your doctor before your child is born.

Here are some recommended items that you can bring:

• A bottle of formula or breast milk
• Bathing items (if your baby can bath between casts)
• Permanent marker- to mark the toes after cast is applied
• Leg warmers
• Receiving blankets or muslin
• Noise blocking headphones- for the cast removal if the sound upsets your child
• A list of any questions you may have for the doctor
• Extra clothing to change your child into if plaster gets on it