Hesperian Health Guides
Method 2: Plaster Casts
This method uses a casting technique similar to the one for correcting contractures
(see Chapter 59). A club foot is gradually straightened in 3 stages:
| Stage A |  |
Stage B | |
Stage C | |
| Straighten the inward bend so that the foot points down. Do not yet begin to lift the foot. | Overcorrect so that the foot points down and out. Keep the foot in this position until the heel no longer turns in but is straight or turns out just a little. | Now bring the foot up, making sure that the outside of the foot is higher than the inside. Overcorrect. | |||
 |
 heel turned in
heel turned out |
 |
 | ||
| STAGE A | ||
| 1. In a young baby it is often necessary to cast the whole leg with the knee bent to keep the cast from slipping down. First, wrap cotton padding evenly around the whole leg. | 2. Cast the leg and foot. Make the cast especially thick around the knee and heel, where he is more likely to bump it. | |
 |
Put extra thick padding over bony spots. Put bits of cotton between the toes. (Take them out after the foot has been cast.) |
 |
| 3. After the plaster is dry, cut out a wide ring from heel to mid-foot. | 4. Gently and slowly begin to stretch the foot OUT and DOWN. (Do not try to bring it up yet.) | 5. To keep edges of cast from hurting the skin, bend them out with pliers. | |
 Make it wider on this side. |
 |
 | |
| 6. Put a ring of cotton or soft gauze over the foot and cover with new plaster bandage. Hold the foot in the new position until the plaster hardens. |
7. Once or twice a week take off the outer ring of plaster, bend the foot down and out a little more, and cover with a new ring of plaster. | ||
| Press the soft plaster into groove and smooth with fingers. | 
gauze
new plaster |
 | |
| STAGE B | |||
| 1. Remove the whole cast and check the position of the heel. |  |
Often the heel still bends in even after the bend of the foot has been corrected. |  |
| BACK VIEW | |||
| BEFORE | AFTER | ||
| 2. If so, keep casting the foot in a down and out position until the heel is straighter. | heel still bent in |  |
 |
| STAGE C | |||
| 1. After the sideways twist of the foot and heel is corrected, begin to raise the foot, using casts. | 2. As you wrap the foot with plaster bandage, hold it in a raised position with 2 fingers. | ||
 | |||
| 3. Hold the foot up as the plaster dries. | As you hold the foot, keep it turned outward so that the little toe is always higher than the big toe. | ||
 |
 | ||
| Take care to keep the toes straight. | 4. Keep raising the foot little by little using the same casting method as before. | ||
 |
YES |  |
Bend up cast edges with pliers. |
| NO | |||
CAUTION! Be very careful cast does not pinch or dig into skin here.) |
5. Raise the foot a little in this way once or twice a week until it is as high as this, or until it stops raising for 3 or 4 cast changes. | ||
 |
 |
 |
 |
This child was born with a club foot. Village rehabilitation workers used a series of casts to straighten it. First they corrected the inner bend of the foot. |
 |
 |
 |
| Then they gradually lifted her foot by cutting out rings on the cast, closing the space, and holding it closed with a new strip of plaster. | ||
| After 4 months of casting, the foot was in a good position. |  |
|
|
IMPORTANT! After a club foot has been corrected, great care is needed to prevent it from coming back. Both exercises and braces are essential. After strapping or casts have been removed, continue the recommended stretching exercises twice a day. See braces for use after correcting club feet. Many children need to wear braces until they stop growing(age 13 to 18). If the problem keeps returning, surgery is probably needed. |
 |
| This child who had club feet needs to use braces day and night, at least until he begins to walk, and still at night after that. | |
| Check his feet regularly, for years, for any sign that the foot is beginning to turn in again. Improved bracing may be required. |
This page was updated:25 Nov 2024