The casting stage can be the most trying time for a Mom & Dad on a little one’s clubfoot journey. This can be due to the fear of the unknown, the fear for our baby, the discomfort caused to our child and the inability to alleviate said discomfort. Additionally, many parents do not know of clubfoot diagnosis prior to birth further exaggerating the anxiety for the parents. Therefore difficulty adjusting to casts can be felt by both parents and the clubfoot baby.
When addressing the cast(s) in regards to the baby, follow our checklist to ensure everything is correct:
Bottom of the cast
□Check the toes
□ Are they pink?
□ Are they blue & cold?
□ Are the toes swollen?
Sometimes the toes are not as pink as you would like and may feel cold to the touch. To check the circulation in the toes, press on the toes they will turn white and immediately pink. If this is true the circulation is fine. If they do not return to pink, seek medical assistance to have the cast removed.
Draw Your Line
□ As described in our blog post “Best Items for a Clubfoot Baby” a sharpie can be your best friend to ensure casts aren’t slipping.
***Draw a link on top of the toes the length of the toe opening of the cast, if the line disappears, the cast(s) is slipping call your doctor immediately. If Doctor is unavailable the general advice is to remove the cast(s). Incorrect or slipped casts can cause further complications can further disfiguring the foot.
Tops of the casts□ How do the thighs look?
□ Are they irritated?
□ Is there chaffing of the casts either against the leg or groin area?
□ Are the tops of the cast(s) sufficiently padded?
Remember too much padding can also cause discomfort and restrict circulation. To add additional padding without using space (there should be some space between the top of the thigh and the cast for movement) use adhesive moleskin.
□ Is the child able to lift and move their legs?
The weight of cast(s) can vary and is dependent on the material used to cast. The true Ponseti method is with plaster casts which are heavier. Some doctors have started using ‘soft’ cast(s) that are easier to remove (at home) by unwrapping. These are lighter.
Gas□ Is it possible your child has gas?
□ Is your child constipated?
The restricted movement of the legs can make it hard for your child to pass gas or bowel movements. You can give gas drops (please check with your doctor) or try doing the “bicycle” motion with your child’s legs to alleviate and help move along gas and bowel movements.
Another trick I picked up, if you put a little Vaseline on their bumhole it can help stimulate and pass bowel movements.
□ Is your child in a comfortable sitting position/laying?
□ Are casts digging into them?
□ Is there pressure on the hips?
If the child is laying down, try rolling a small muslin or a receiving blanket and placing under the knees to take the pressure off the hips.
□ Try having your child sleep on a slight incline.
Ensure their head is slightly above the high of the elevated legs as to not cause circulation problems.
Now check yourself & your partner:
□ Are you anxious or apprehensive with the casts?
Remember babies can feel what mommy feels. If you’re upset, scared or nervous with the cast(s) the baby will interpret your feelings. Try and become accustom the cast(s), embrace them and continue to pick-up and hold your baby as much as you can.
□ Do you know the warning signs for improper casting?
(Hint they are above ;-) )
□ Are you doing the best you can for your child?
(Certainly, if you’re loving, feeding and snuggling them this is the best medicine)
□ Do you have adequate support?
□ Physical support
Easing the Casting Phase:
Some tips and tricks I did and I have picked up from all the wonderful Mama’s in our large Facebook-Clubfoot Community:
□ Check our infographics blog post “Best Items for a Clubfoot Baby”
□Wear your child.
This can be done in both casts and boots and bar. For more information check the Facebook group: “Baby-Wearing for Clubfoot Babies” If you child has additional needs there is a Facebook group for “Special Needs Baby-wearing”.
□ Swaddling young babies can help. We suggest the Embe Baby Swaddle.
The Embe swaddle is recognized as the best swaddle for babies as it does not limit hip movement. Even better for clubfoot children it allows the casts & toes to be at all times without unwrapping the child. Swaddling the hips can be dangerous and increase the chances of hip dysplasia, something clubfoot children are already more likely to have.
□ Sleeping your child in a bouncer or swing*
*This is not recommended by SIDS advocates and I personally never did this myself. (I never did this myself as I co-slept and I didn’t want my child to “need” the motion to sleep – It's all about the sleep training in my house. Both my CF and non-CF babe slept through the night by 4 months old)) However, many, many people with clubfoot (and non-clubfoot) children do this. Please check with your doctor and the safety restrictions on the apparatus you are using prior to sleeping your child in it.
As mentioned above this was our method. Ensure child is in its own bed and close (within arms touch) to you. Try a Doc-A-Tot as a co-sleeping option.
□ White Noise Machine
I swear by these, especially if you have other children/people in the house. We still use ours at 20 months old.
□ Tylenol or Motrin
Ok this one is a big one. A lot of people will suggest this. To me, it makes “sense” as to why someone might suggest this. I often explain to my family and friends when they would ask if it is painful that the casting phase is similar to braces (on teeth). The foot in casts is gently manipulated, much as teeth are using braces to turn and achieve their correct placing. The feet are enduring pressure. Therefore, some people use Tylenol or Motrin to alleviate the discomfort of the pressure. However, I did not. I took the natural approach and fed my child when I thought him to be in pain. Please speak to your doctor prior to administering. Babies in casts should not be in real pain, uncomfortable yes, but not pain. If your child is in true pain the cast(s) are LIKELY incorrect and you should call your doctor.
At the end of the day, you know your baby best. All suggests provided are just that, suggestions. Do what feels right for you and your child and you will both get through this.Disclaimer: With this article as any of our blog posts, please consult a doctor. We are not a doctor and do not claim to be. We are in no way liable for any actions you take or do not take. Happy Casting!