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| Orthopaedic Cast Removal At Home |
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Orthopaedic cast removal, or even soaking the casts to have them
removed at the clinic, is a task that daunts many parents. However,
soaking and / or removing a cast is a task you very well may find
yourself doing if your child's clubfoot is being treated via the Ponseti
Method and you live far from the clinic.
As a rule, at-home cast removal is not part of the Ponseti Method of
clubfoot treatment until the very last cast is ready to come off and the
foot abduction brace is about to go on (photos below). If your doctor
ever tells you to remove the casts at home the night before an
appointment to put another cast on, this is a serious error and shows
your doctor is not using the Ponseti Method despite any claims he or
she may make to the contrary.
The reason you don't want to take a cast off the night before, or even
the morning before an afternoon appointment, is because the clubbed
foot can begin to loose correction almost immediately. If a cast is
removed the night before, the foot is given several hours, probably
more than half a day, to begin pulling back in to the clubbed
condition...and it will. Happily!
Even so, you may likely be asked to soak the cast prior to an office visit
to remove it, so knowing how to effectively soak the baby's cast is
useful information. The easier the cast comes off, the easier it is on
the baby to have it removed.
Your goal here is to time the soaking process with your clinic
appointment. You want to be done with the soaking just in time to
wrap the baby and head out the door to see the doctor. Plan on
giving this process thirty to forty minutes start to finish.
To prepare for soaking off a cast, you will need the plastic bath tub,
several hand towels and wash cloths for padding, white vinegar, a small
spoon, and if it is available, something that can suck up water and push
it out again, like a turkey baster. Also, you will need to have a clean
table top or counter top to lay the baby on when you are done -
prepared ahead of time with a towel or blanket on it, plus a roll of
paper towels, and small trash sacks or plastic shopping bags (only one
per casted leg). Plus whatever clothing the child will wear to his clinic
appointment.
Once all this is gathered up begin your soaking bath.
For newborn babies who cannot sit up, you will want to use a plastic
baby-bathtub as shown in the photo below.
Notice how Garrison is propped up with towels to keep him
comfortable and to prevent him from slumping over too far in the
water. A wash cloth covering him helps prevent any chill. He is four
weeks old here and we are soaking off his first set of plaster Ponseti
Serial Casts at the Ronald McDonald House in Iowa.
In to the bath water, add vinegar. How much? It's hard to say exactly,
but a considerable amount such as a cup full. This is probably more
than the clinic would recommend, but the "couple tablespoons" we
were told to use had no effect at all. After three kids, I figured out it
took a lot more to be beneficial. Also - there were never any ill effects
on my babies skin due to the higher amounts of vinegar being used.
Now as the baby is warm and cozy in his bath, use a cup, or a large
syringe, or even a big turkey baster to force the water underneath the
casts at the thigh and toe openings. This lets the water & vinegar
solution work from both the outside and the inside.
Meanwhile, start kneading the cast just as you would bread dough,
gentle, yet firm. The idea is to start forming little hairline cracks in the
plaster that will let water soak in. In a little while you will begin to
notice the plaster is softening, especially around the thigh where the
plaster is probably the thinnest. As you knead to soften the plaster,
also start to pick at both the knee and the heel area (the two thickest
areas of plaster) with the rounded edge of your spoon.
My technique was to use a breakfast spoon to begin scratching through
the knees and heels, just a small hole to let the water get in. As the
water is able to penetrate the plaster, it begins to soften the cast for
easier removal.
With in twenty to thirty minutes, the whole cast should be fairly soft
and saturated with liquid. Even if it isn't completely
On a near by table top have a blanket or towel spread out for the baby
to lay on. Remove him from the water and lay him out.
Wrap the cast(s) in several layers of paper towels, then take some of
the water from your tub and pour it over the paper towels to saturate
them. Next, slip the plastic sack over the paper towels and wrap it on
well so it will neither fall off nor leak any liquid. You can do this by
gathering the top of the sack above the cast at the thigh and twisting
the sack closed, then tucking in the remaining part to hold it.
Some people use hand towels for this task but I found that in the
chaos of the clinic appointment, twice I ended up leaving my good
towels behind - so I went to using paper towels that could simply be
thrown away at the clinic (with nothing wet to carry back home with
me).
Dress the baby appropriately in to something that will be easy to
remove at the clinic, and head out to see your doctor.
Take an extra change of cloths to your appointment - the pants your
baby wears will end up damp from the wet casts you are going to have
removed at the clinic.
Make sure any pants you take are loose fitting and easy to apply over a
new cast (new casts need treated gently during the first 24 hours) -
and really better yet, avoid pants if possible, using a blanket to wrap
the baby in instead.
1) It is the very last cast and the doctor has instructed you to remove
them and slip the baby immediately in to his FAB.
2) The casted leg has begun to swell and needs to have the cast
removed immediately to prevent serious medical problems to the leg.
Cast Removal at home will be very simple if you don't cut corners on
the soaking process outlined above. Because you are not in any hurry
to get to a clinic, you may soak longer if needed.
After soaking, my husband Chriss used small scissors to cut off the
casts, making a small seam down each side, then "breaking" them apart
much like cracking open an egg.
A certain amount of redness is to be expected on the baby's skin. You
may also find dead skin built up and possibly a bad smell. A good bath
will take care of this most of the time. Be prepared though, the foot
may look quite ugly indeed! The creases of excess skin have been
bunched up and moist, they may look like deep cuts at first, but once
cleaned up you will see it's just the extra skin. With in a day or two,
the ugliness will be gone. Because the foot grew stretched the wrong
direction, this extra skin is to be expected. In time it will shrink up
and go away.
If you take off a cast and discover open sores, extreme discoloration
and/or bruising, contact your doctor right away!
Once you take the casts off Baby, it's tempting to give him a break -
you know, sort of delay putting on his FAB.... Don't do it!!!
Clubfeet are notorious for wanting to curl back up in to their clubbed
position and will basically fight for that right at every turn over the
first three years after correction is achieved. Put the baby in to his
FAB as soon as the casts are off and you've given him a much needed
and well deserved bath (heck, climb in the tub with him and enjoy
some great mommy-n-me time). Get the FAB on him though with in
that first hour and KEEP it on the prescribed 23 hours a day per the
Ponseti bracing protocol!
removed at the clinic, is a task that daunts many parents. However,
soaking and / or removing a cast is a task you very well may find
yourself doing if your child's clubfoot is being treated via the Ponseti
Method and you live far from the clinic.
- Soaking your baby's orthopaedic
clubfoot casts for removal, and taking
them off at home is not hard if you
know a few little tricks.
As a rule, at-home cast removal is not part of the Ponseti Method of
clubfoot treatment until the very last cast is ready to come off and the
foot abduction brace is about to go on (photos below). If your doctor
ever tells you to remove the casts at home the night before an
appointment to put another cast on, this is a serious error and shows
your doctor is not using the Ponseti Method despite any claims he or
she may make to the contrary.
The reason you don't want to take a cast off the night before, or even
the morning before an afternoon appointment, is because the clubbed
foot can begin to loose correction almost immediately. If a cast is
removed the night before, the foot is given several hours, probably
more than half a day, to begin pulling back in to the clubbed
condition...and it will. Happily!
Even so, you may likely be asked to soak the cast prior to an office visit
to remove it, so knowing how to effectively soak the baby's cast is
useful information. The easier the cast comes off, the easier it is on
the baby to have it removed.
- Whether at home or at the Ronald McDonald
House, soaking off a cast (or two!) is really not
difficult if you know a few key tips to help it
along.
Your goal here is to time the soaking process with your clinic
appointment. You want to be done with the soaking just in time to
wrap the baby and head out the door to see the doctor. Plan on
giving this process thirty to forty minutes start to finish.
To prepare for soaking off a cast, you will need the plastic bath tub,
several hand towels and wash cloths for padding, white vinegar, a small
spoon, and if it is available, something that can suck up water and push
it out again, like a turkey baster. Also, you will need to have a clean
table top or counter top to lay the baby on when you are done -
prepared ahead of time with a towel or blanket on it, plus a roll of
paper towels, and small trash sacks or plastic shopping bags (only one
per casted leg). Plus whatever clothing the child will wear to his clinic
appointment.
Once all this is gathered up begin your soaking bath.
For newborn babies who cannot sit up, you will want to use a plastic
baby-bathtub as shown in the photo below.
Notice how Garrison is propped up with towels to keep him
comfortable and to prevent him from slumping over too far in the
water. A wash cloth covering him helps prevent any chill. He is four
weeks old here and we are soaking off his first set of plaster Ponseti
Serial Casts at the Ronald McDonald House in Iowa.
In to the bath water, add vinegar. How much? It's hard to say exactly,
but a considerable amount such as a cup full. This is probably more
than the clinic would recommend, but the "couple tablespoons" we
were told to use had no effect at all. After three kids, I figured out it
took a lot more to be beneficial. Also - there were never any ill effects
on my babies skin due to the higher amounts of vinegar being used.
Now as the baby is warm and cozy in his bath, use a cup, or a large
syringe, or even a big turkey baster to force the water underneath the
casts at the thigh and toe openings. This lets the water & vinegar
solution work from both the outside and the inside.
Meanwhile, start kneading the cast just as you would bread dough,
gentle, yet firm. The idea is to start forming little hairline cracks in the
plaster that will let water soak in. In a little while you will begin to
notice the plaster is softening, especially around the thigh where the
plaster is probably the thinnest. As you knead to soften the plaster,
also start to pick at both the knee and the heel area (the two thickest
areas of plaster) with the rounded edge of your spoon.
My technique was to use a breakfast spoon to begin scratching through
the knees and heels, just a small hole to let the water get in. As the
water is able to penetrate the plaster, it begins to soften the cast for
easier removal.
With in twenty to thirty minutes, the whole cast should be fairly soft
and saturated with liquid. Even if it isn't completely
On a near by table top have a blanket or towel spread out for the baby
to lay on. Remove him from the water and lay him out.
Wrap the cast(s) in several layers of paper towels, then take some of
the water from your tub and pour it over the paper towels to saturate
them. Next, slip the plastic sack over the paper towels and wrap it on
well so it will neither fall off nor leak any liquid. You can do this by
gathering the top of the sack above the cast at the thigh and twisting
the sack closed, then tucking in the remaining part to hold it.
Some people use hand towels for this task but I found that in the
chaos of the clinic appointment, twice I ended up leaving my good
towels behind - so I went to using paper towels that could simply be
thrown away at the clinic (with nothing wet to carry back home with
me).
Dress the baby appropriately in to something that will be easy to
remove at the clinic, and head out to see your doctor.
Take an extra change of cloths to your appointment - the pants your
baby wears will end up damp from the wet casts you are going to have
removed at the clinic.
Make sure any pants you take are loose fitting and easy to apply over a
new cast (new casts need treated gently during the first 24 hours) -
and really better yet, avoid pants if possible, using a blanket to wrap
the baby in instead.
There are only two times you should ever
remove the cast at home:
1) It is the very last cast and the doctor has instructed you to remove
them and slip the baby immediately in to his FAB.
2) The casted leg has begun to swell and needs to have the cast
removed immediately to prevent serious medical problems to the leg.
Cast Removal at home will be very simple if you don't cut corners on
the soaking process outlined above. Because you are not in any hurry
to get to a clinic, you may soak longer if needed.
- The photos to your left show the step by step process of
removing casts at home. I hope you'll notice how calm Garrison
was during the process - good soaking makes for easy cutting,
which leads to a calm baby. Like everything else with the
Ponseti Method, pain and anxiety have no part in the clubfoot
treatment process.
After soaking, my husband Chriss used small scissors to cut off the
casts, making a small seam down each side, then "breaking" them apart
much like cracking open an egg.
A certain amount of redness is to be expected on the baby's skin. You
may also find dead skin built up and possibly a bad smell. A good bath
will take care of this most of the time. Be prepared though, the foot
may look quite ugly indeed! The creases of excess skin have been
bunched up and moist, they may look like deep cuts at first, but once
cleaned up you will see it's just the extra skin. With in a day or two,
the ugliness will be gone. Because the foot grew stretched the wrong
direction, this extra skin is to be expected. In time it will shrink up
and go away.
If you take off a cast and discover open sores, extreme discoloration
and/or bruising, contact your doctor right away!
Once you take the casts off Baby, it's tempting to give him a break -
you know, sort of delay putting on his FAB.... Don't do it!!!
Clubfeet are notorious for wanting to curl back up in to their clubbed
position and will basically fight for that right at every turn over the
first three years after correction is achieved. Put the baby in to his
FAB as soon as the casts are off and you've given him a much needed
and well deserved bath (heck, climb in the tub with him and enjoy
some great mommy-n-me time). Get the FAB on him though with in
that first hour and KEEP it on the prescribed 23 hours a day per the
Ponseti bracing protocol!
| Garrison has outgrown his "coming home" casts, at this point we decided to remove them. Ponseti Method Photos top and bottom. |
| For cast removal at home, this photo shows Garrison soaking in our kitchen sink. |
From soaking, to removing the
casts at home, this large
photo to your right shows
Garrison's previously clubbed
feet just moments after the
casts were taken off and he
was given a bath. Next photo
to your right is approximately
thirty minutes later, he is
wearing his first Mitchell foot
abduction brace.
casts at home, this large
photo to your right shows
Garrison's previously clubbed
feet just moments after the
casts were taken off and he
was given a bath. Next photo
to your right is approximately
thirty minutes later, he is
wearing his first Mitchell foot
abduction brace.
These four photos show a very brief treatment
outline:
Feet at birth
Dr. Ponseti applying casts
Feet after first cast
Feet after 2nd cast.
It is a correct assumption to look at these photos
and say, "But Garrison's feet were not as severe as
my own child's clubfeet." In truth, they were not as
severe as some, nor were they as severe as the
clubbed feet of his two older brothers - but the
Ponseti Method works on clubfeet regardless of their
severity 95% of the time. You have absolutely
nothing to loose by trying the Ponseti Method - but
remember, if you opt for a surgical correction first,
the Ponseti Method will not be available to you later
- it only works on feet that haven't been surgically
altered already.
With that said, don't despair. If your child has had
surgery and still suffers from this crippling birth
defect, the fine doctors at the Ponseti Clinic may
still find better ways to help your child. It's always
worth consulting with them!
outline:
Feet at birth
Dr. Ponseti applying casts
Feet after first cast
Feet after 2nd cast.
It is a correct assumption to look at these photos
and say, "But Garrison's feet were not as severe as
my own child's clubfeet." In truth, they were not as
severe as some, nor were they as severe as the
clubbed feet of his two older brothers - but the
Ponseti Method works on clubfeet regardless of their
severity 95% of the time. You have absolutely
nothing to loose by trying the Ponseti Method - but
remember, if you opt for a surgical correction first,
the Ponseti Method will not be available to you later
- it only works on feet that haven't been surgically
altered already.
With that said, don't despair. If your child has had
surgery and still suffers from this crippling birth
defect, the fine doctors at the Ponseti Clinic may
still find better ways to help your child. It's always
worth consulting with them!
| This photo shows that clubfoot doesn't stop Garrison (age 17 months) from keeping up with us on the nature trails! Here he is at the Devil's Millhopper State Park in Gainesville, FL |
| Return to Plaster Orthopaedic Cast Removal Top of Page six-feet.com |