Name of the Procedure:

Wedging of Clubfoot Cast
Also known as: Cast wedging, Cast modification for Clubfoot

Summary

Wedging of a clubfoot cast is a procedure where a wedge is inserted into a previously applied cast to correct the alignment of a clubfoot. This technique gradually and gently adjusts the foot's position without needing to replace the entire cast.

Purpose

Medical Condition: Clubfoot (Congenital Talipes Equinovarus)
Goals: To improve the foot's alignment, enhance the effectiveness of the original cast, and avoid the necessity for surgical correction. The expected outcome is better foot positioning, leading to more normal function and appearance.

Indications

• Congenital clubfoot that has been initially treated with casting.
• Patients in whom initial casting did not completely correct the deformity.
• Ensuring continuous improvement in alignment between cast changes.

Preparation

• Instructions: No special fasting or medication adjustments are generally required.
• Assessments: Routine examination of the foot and cast fit by an orthopedic specialist.

Procedure Description

1. The existing cast is carefully inspected to assess the current foot position.
2. A cut is made in the plaster or fiberglass cast, usually on the medial side.
3. A sterile wedge of medical foam or plaster is inserted into the cut area.
4. The cast is re-secured and reinforced with additional plaster or fiberglass to maintain the correction.
5. The foot alignment is re-evaluated to ensure the optimal position.

Tools: Cutting tools (cast saw), wedges (foam or plaster), plaster or fiberglass materials for reinforcement.
Anesthesia: Typically not required; local discomfort controlled by analgesics if needed.

Duration

The procedure generally takes about 15-30 minutes.

Setting

The procedure is done in a hospital orthopedic outpatient clinic or specialist orthopedic office.

Personnel

• Orthopedic Surgeon: Evaluates and performs the procedure.
• Nurse or Cast Technician: Assists with the procedure and patient comfort.

Risks and Complications

• Common Risks: Skin irritation or pressure sores, minor discomfort.
• Rare Risks: Infection, slippage of the wedge causing improper alignment, cast damage necessitating a replacement.

Benefits

• Gradual, non-invasive correction of foot alignment.
• Avoids the need for more invasive surgical procedures.
• Immediate improvement in foot position, with gradual improvements continuing over weeks or months.

Recovery

• Care: Regular follow-up appointments to monitor foot alignment and cast condition.
• Restrictions: Limited weight bearing as instructed by the physician.
• Recovery Time: Varies; typically, the child will wear successive casts for several weeks to a few months until optimal alignment is achieved.

Alternatives

• Other Treatments: Serial casting (performing multiple complete cast changes), surgical correction.
• Pros and Cons: Serial casting involves more frequent cast changes, while surgical correction may provide quicker results but involves higher risks and recovery time.

Patient Experience

• During Procedure: The child may experience some discomfort when the cast is cut or adjusted, but it is generally minimal.
• After Procedure: Some mild soreness but significant pain is uncommon. Pain management may include over-the-counter pain relievers.
• Comfort Measures: Ensuring the cast isn’t too tight and educating caregivers on monitoring for signs of complications.