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How are Ponseti casts for clubfoot applied?
Ponseti method casting for clubfoot is done in two parts. First, the lower half of the cast is applied with plaster or soft cast and molded carefully. This half of the cast extends from the toes to just below the knee. After this, the knee is flexed, and the upper portion of the cast is applied, which extends to the upper thigh. The upper portion of the cast may be done with plaster or with a material called soft cast; both perform the function of holding the knee in the flexed position.
Casts are applied by two members of the clubfoot casting team; the first person holds the leg and foot in place while the second person applies the Ponseti cast. The cast is then carefully molded while the plaster or soft cast sets to hold the foot in position. Once the plaster hardens, we trim the material around the toes. The leg is then held and the knee flexed while the upper leg is wrapped with cotton and then cast material placed.
You may notice mild swelling of the toes the day the cast is applied. The toes should always have good circulation; this can be checked by pinching the toes and watching them change from white while pinching, back to the usual skin color when the pinch is released. If the toes are dark and cold and do not whiten with a pinch, this may mean that the cast is too tight. In this case, contact your Gillette care team right away to remove the cast.
How do I care for a Ponseti cast?
Protecting a Ponseti clubfoot cast from moisture can be difficult, but it is very important. Bathing is often part of a daily routine, the weather can be unpredictable, and bodily fluids can be difficult to control. Wrapping the cast in a bag and attempting to bathe or swim without it getting wet does not work.
If the cast gets wet, the padding underneath will retain moisture and hold it against the skin. Trapped moisture can cause skin issues, allow for cast slippage, or create a foul odor inside the cast. If your cast is made of plaster, it will soften when wet and won’t maintain proper foot position during the treatment window. If the cast becomes wet or soiled, please contact Telehealth right away.
Gillette’s recommendation is to give sponge baths while the patient is in a Ponseti cast.
Skin and Slipped Cast Considerations
Check daily to ensure the cast has not slipped. A cast that has slipped can change the shape of the foot, become too tight, or increase the risk of pressure sores occurring. Gillette encourages you to take pictures of the toes after the application so you can compare them with the current foot position if you suspect slippage. If in doubt, please contact Telehealth right away. You will be able to share your photos with the Telehealth nurses for the providers to review. Upon review, they may recommend you remove the cast at home. If you are certain a cast has slipped, you may remove the cast right away and then contact the team to set up an appointment for cast re-application.
- Toes and fingers in the cast should stay pink and feel warm to the touch. To test for proper blood circulation, apply pressure to the fingernail or toenail. The nail should turn pink within 5 seconds after the pressure is released.
- Swelling in a cast is possible, elevation of the limbs can help the blood re-circulate.
- When changing diapers, please don’t pull on the casts, but instead support the legs with your hand and lift the casts and legs.
For the Ponseti cast to do what it needs to, it needs to stay intact until your scheduled date of removal. It’s easy to shift the padding inside the cast, which can cause the padding to tighten, circulation disruption, and/or skin issues.
Avoid picking at or pulling things out of the cast. Do not stick anything inside of the cast, including your fingers.
If the cast cracks or breaks, the heel has gotten soft, or the padding has been disrupted, it needs to be repaired or replaced, so please contact Telehealth right away.
Contact Telehealth right away if you notice any of the following:
- Toes appearing to have slipped back into the cast.
- Cast that has gotten wet or soiled.
- Your child is inconsolable for no apparent reason.
- A new stain originates from inside the cast.
- Unusual or foul odors are coming from the cast.
- Changes in color or temperature in the toes or fingers.
- Skin irritation or rashes.
- Cracking/breaking of the cast.
- Unexplained fever of 101.5°F (38.6°C) or greater.
- A foreign object inside the cast.
How do I remove a Ponseti cast at home?
Please read these full instructions in order to avoid impacting the results of the next step of clubfoot casting. This information is for educational purposes only.
You may remove your child’s casts at home on the morning of your next casting appointment. Please do not remove the casts the night before your appointment; this will allow greater time for the foot to tighten up, which can impact our ability to stretch and correct the foot at the next casting. This may ultimately result in more casts and a longer period for correction of the clubfoot.
Removing plaster is messy, and the plaster pieces tend to fly all over. Plaster should not go down the drain because it can clog your plumbing. Give yourself extra time before your appointment so you don’t feel rushed to get the cast off and make your appointment slot. The plaster cast will come off with enough water, time, and massaging. Be patient, and don’t panic: removing a single clubfoot cast can take upwards of an hour, but you will get better at it each time you do it.
- If the cast is plaster overwrapped with Coban, unwrap the Coban before soaking the plaster. Don't soak the Coban.
- Soak the cast in warm water for about 15 to 20 minutes. You can do this in a basin, a portable baby bath, a large plastic bag, or a soaking wet towel.
- You can add clear vinegar to the water to soften the plaster.
- As the plaster begins to break down, massage the cast to speed up the process.
- There may be a plaster knob left on the cast, indicating the end of the roll. If this is the case, begin unwrapping at this knob once the plaster starts separating into layers (delaminating).
- If there isn't a small plaster knob, once the plaster begins to delaminate, clip the leading edge of the plaster with scissors starting at the thigh and begin unwrapping the layers.
- The foot portion of the cast usually slips off the toes.
- Clean the leg, massage it, and apply lotion.
- Find the end of the soft cast roll. It will either be folded over as a tab or smoothed flat. Either way, this will be the best place to start unwrapping the cast. You may need to work your fingernail underneath the end to get it started.
- Once the soft cast has been unrolled, unwrap the cotton padding and remove the stockinette from the upper thigh.
- Clean the leg, massage it, and apply lotion.
If the cast is plaster overwrapped with soft cast, the removal process is a combination of both types. Unwrap the soft cast, then soak the plaster cast—do not soak the soft cast. Before getting the plaster wet, make sure you remove the padding from the upper thigh along with the stockinette cuff.
What if I have questions about Ponseti cast care and removal?
If you have any questions or concerns about removing a clubfoot cast, please call:
Gillette Telehealth 24/7: (651) 229-3890 (Toll-free: 1 (800) 719-4040)
Burnsville Clinic: (952) 223-3400
Maple Grove Clinic: (763) 496-6000
This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team.
If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.
