Applying

Clubfoot Casts

Dr. Cornelius Mukuzunga

Orthopaedic Surgeon KCH
Learning outcomes

• Know the roles of manipulator and caster

• Demonstrate ability to find the head of talus
• Outline what makes a good cast
• Demonstrate ability to communicate plan with parents
• Understand it takes TWO people to cast

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Positioning the baby

• May depend on age and size of baby

• If on mother’s lap:
o Left clubfoot
o Left breast for feeding
o Left manipulator
• Sit on table if too low

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Positioning the baby

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Roles of manipulator and caster

• Manipulator directs the caster

• Manipulator holds foot after
manipulation
• Caster puts on cast
• Caster puts on cast
• Constant conversation

TWO people to cast

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Position of manipulator and caster
Caster
• Manipulator stands
on the outside
• Caster stands on
inside
• Both face the
affected foot

TWO people to
cast

Manipulator
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 Before starting

• Know the aim of your cast

• Manipulator does gentle manipulations before
casting for about 60 seconds
• Use continuous pressure for a couple of seconds
before starting cast

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Manipulating and applying
the underwrap
• Manipulator holds the
corrected position
• Caster applies
underwrap snugly
• Wrap over
manipulator’s fingers

TWO people to cast

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Manipulation and applying the cast

• Cover toes by the tip

of your thumb and
index finger; prevent
crowding
• Manipulator keeps
their fingers inside
the cast
• Apply cast over
fingers and toes

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Manipulation and applying the cast

• 3 turns over the toes

• Overlap each layer
by half
• Wrap snugly over foot
and ankle
• Looser over calf to
prevent pressure
on muscles
• Do below-knee part
first

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 Manipulation and applying the cast

While below-knee cast still soft:

• Manipulator holds new position gently, taking care not
to leave pressure point over talus
• Moulds cast round heel
• Complete the below-knee part first, then complete to
groin with knee at 90°

Toe to groin casts

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Applying the cast

• Mould plaster gently

• Be precise
• Mould above heel to prevent slipping
• Trim back to see the top of toes

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Applying the cast

Quickly discuss with your neighbour &

answer (2 mins)

1. How much pressure should you use?

2. What is the length of the cast?
3. What is the angle of the knee?
4. At what time do you manipulate?
5. How many trained practitioners?

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Applying the cast

1. Amount of pressure? Gentle

2. What is the length of cast? Start below
knee and extend to above thigh. Toe to
groin casts
3. What is the angle of knee? 90°
4. At what time do you manipulate?
No manipulation AFTER casting
5. How many trained practitioners?
TWO people to cast

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Applying the cast

• Manipulate
• Apply padding and
hold in position
• Apply below-knee
cast and mould
• Complete to groin

Toe to groin casts

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After the cast

• Check toe circulation

• Discuss caring for the cast
with parents

Keep talking to parents

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Cast care for parents and
potential problems
• Don’t get the cast wet
• Don’t let child walk too much

What would your plan be if:

• the cast slips down (toes disappear up into cast)?
• the cast falls off?
• a bad smell comes from the cast?
• the toes are swollen?
• the baby continues to be distressed?

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What is wrong with this cast?

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What makes a good cast?

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What makes a good cast?

• Underwrap all the way up to groin

• Cast all the way up to the groin: Toe to groin casts
• Well moulded
• Toes visible and supported by POP
• Knee flexed to 90° (babies)
• When POP quality is poor, consider anterior slab
and footplate

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A good cast

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Cast removal

Keep talking to parents

• Cast removed at the clinic on
morning of clinic

• Check the cast before

removal
• Note areas to reinforce and
how well it holds the foot

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Key messages

1. A comfortable parent and child help create a good cast

2. TWO people to cast
3. Know your goal for each cast
4. Know your roles and where to stand
5. Toe to groin casts
6. Communicate constantly
7. Have a plan for after the cast
8. Keep talking to parents

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