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Casting Care Instructions

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

After the foot is in this position for 4 to 7 days, the muscles and ligaments will stretch enough to make further correction possible. The cast is removed and the same process of gentle massage and manipulation is repeated approximately 5-6 times until your doctor feels adequate correction has been achieved.

To complete the correction, the heel cord (Achilles tendon) is clipped (tenotomy) in about 85% of the babies before the application of the last plaster cast. The tenotomy is done under local anesthesia (sometimes under sedation or general) with a very thin scalpel. A few drops of blood usually stain the back of the cast to the size of a quarter. This is normal and it does not mean that the puncture wound is actively bleeding. The tendon reattaches with no weakness in 2-3 weeks.

After the Cast Application
The first 24 hours after the cast is applied, your baby may be a little fussy / restless but he/she should be comfortable after that time. Please perform the following:

Check the circulation in the foot every hour for the first 6-8 hours after application, and then 4 times a day. This is done by pinching the toes and watching for the color to return to the toes. The toes will turn white and then quickly return to pink if the blood flow to the foot is good. This is called blanching. If the toes are dark and cold and do not blanch (white to pink), the cast may be too tight. If this occurs, call your doctor immediately

The top of the toes should be exposed. If you cannot see the toes, it may mean the cast has slipped and correct reduction is not being maintained. Call your doctor immediately if this happens.

Keep the cast clean and dry. The cast may be wiped with a slightly dampened cloth if it becomes soiled.

The cast should be placed on a soft surface for the first 24 hours, because it takes this long for the cast to completely dry. Whenever your child is on his/her back, place a pillow or towel roll under the cast to elevate the leg so that the heel extends just beyond the pillow or towel roll. This prevents pressure on the heel, which could cause a sore.

Use disposable diapers and change the baby often to prevent cast soiling. Apply the diaper above the top of the cast to prevent urine from getting inside the cast. Diapers with elasticized legs work well.

Before the next cast is applied
A new cast will be applied every 4 to 7 days. The cast will be removed with a special cast knife so the cast must be softened the day you are coming to the clinic. If your doctor instructs you to soften the cast before your appointment, here are some suggestions. Put your child in a tub or sink, making sure that warm water is getting inside the cast (approximately 15-20 minutes). After the bath, wrap a soaking wet towel around the cast and cover with a plastic bag. A bread sack works well for this. If you must travel a long distance, or if you prefer, the bath can be done at the clinic. However, DO NOT SOAK OR REMOVE the cast the day before your appointment.

When to call your doctor
Immediately contact your health care provider if any the following occur:

Blanching of toes does not occur
Any drainage on the cast
Any foul smelling odors coming from inside the cast
If the skin at the edges of the cast becomes very red, sore, or irritated
If your child has an increased temperature of 101.3 degrees F (or 38.5 degrees C) or higher without a reason, such as a cold or virus

After last cast - bracing
Following the removal of the last cast and in order to prevent relapse, shoes attached to a metal bar will be worn 23 hours a day for 2 to 3 months, and thereafter at night and during naps for an additional 3 to 4 years. The first and second nights of wearing the splint, the baby may be uncomfortable, but the braces should not be removed. After the second night, the baby adapts and usually tolerates the brace well. Relapses will almost always occur if the shoes on the metal bar are not worn, even though the feet look and move normally. Three or four yearly visits will be scheduled for the first 3 to 4 years to check for possible relapses. Always bring your child’s brace to your appointment.