Name of the Procedure:

Application of clubfoot cast with molding or manipulation, long or short leg

Summary

This procedure involves applying a specialized cast to reshape a clubfoot, a condition where the foot points downward and inward. The cast is molded to correct the foot's position gradually. The cast may extend from the toes to just below the knee (short leg) or the hip (long leg).

Purpose

The procedure addresses congenital clubfoot, a deformity where a newborn's foot is turned inward. The goal is to realign the foot into a normal position, improve walking ability, and reduce the need for surgical correction.

Indications

• Diagnosed clubfoot in infants or young children
• Secondary clubfoot due to conditions such as spina bifida or cerebral palsy
• Unsuccessful conservative treatments like stretching exercises

Preparation

• No special dietary restrictions or fasting required
• Initial diagnostic tests like X-rays or ultrasound to assess foot deformity

Procedure Description

1. The child is comfortably positioned.
2. The healthcare provider manipulates the foot into a more natural position.
3. A soft padding is applied to protect the skin.
4. Plaster or fiberglass cast material is wrapped around the foot and leg.
5. The cast is molded to maintain the foot in the corrected position.
6. The cast is allowed to harden and set.

Tools: Plaster or fiberglass casting materials, padding

Anesthesia: Usually not required, though a mild sedative may sometimes be used.

Duration

Approximately 30 to 45 minutes

Setting

Performed in a hospital or outpatient clinic

Personnel

• Orthopedic surgeon or specialist
• Trained nurses or casting technician
• Pediatrician (in some cases)

Risks and Complications

• Skin irritation or sores from the cast
• Muscle tightness or stiff joints
• Cast slipping or breaking
• Rarely, nerve damage or impaired circulation

Benefits

• Progressive correction of foot deformity
• Improved foot function and alignment
• Enhanced mobility and gait
• Reduced likelihood of requiring surgery

Recovery

• Follow-up visits every 1-2 weeks for cast adjustments
• Cast typically remains on for 6-8 weeks, followed by bracing
• Limited physical activity while wearing the cast
• Regular skin and circulation checks

Alternatives

• Serial casting with the Ponseti method
• Surgical correction if casting is ineffective
• Physical therapy for mild cases

Pros and Cons of Alternates:

• Serial casting: less invasive, but requires multiple sessions
• Surgery: potential for quicker results, but involves greater risks

Patient Experience

• Minimal discomfort during application
• A sensation of tightness initially, which usually subsides
• Possible mild soreness or itchiness under the cast
• Pain management with over-the-counter analgesics if needed
• Encouragement to stay still during casting to ensure proper setting

This procedure aims to provide an effective way to correct clubfoot, enhancing the child's ability to walk and play normally.