Is casting scary?

Sometimes it happens that the diagnosis and treatment of metatarsus adductus occurs too late and instead of the UNFO orthosis it becomes necessary to apply a plaster cast. Is casting as scary as we think?

We often come across questions about how a child copes with casts on, whether this makes the child’s life more difficult, delays their development, and how to cope with the time spent in casts?

If your child’s treatment has started too late to use a UNFO orthosis, the appropriate treatment step is to apply a cast to correct the forefoot adduction. In this situation, many parents worry whether the cast will delay or slow down the child’s movement, whether such a cast is uncomfortable for the child and whether the child has to sit still while the cast is on.

First of all: don’t panic! It doesn’t help. Parents’ common concerns stem from the opinion that a cast is harmful to a child, and also stem from the false belief that a cast is not comfortable. Let’s face this last opinion first.

In the treatment of forefoot adduction, we use the Ponseti method of casting, which is a revolution in the treatment of clubfoot. Clubfoot is a very complicated foot deformity and much more complicated than MTA. Some elements of this method can be successfully introduced to the treatment of other foot defects. Why? Because the cast applied according to the Ponseti method assumes a series of manipulations (manual manipulations stretching contracted/shortened soft tissues) and precise modeling of the material on the foot and leg before its application. Correction is achieved by following the biomechanics of the foot, i.e. in accordance with the structure of the joint surfaces, bringing the foot to the correct anatomical relations and „blocking” the correction obtained with a plaster cast for 5-7 days. During this time, abnormal joint surfaces are rebuilt and problematic soft tissues are evenly stretched (tissue stress that occurs during redressing is released when the cast is applied), allowing for weekly changes in foot position, and thus correction of deformity components. Such a cast must be well-modeled and meet certain „conditions”. And in order not to cause greater damage with the cast, a qualified team of SPECIALISTS is necessary in the treatment, who have the appropriate knowledge and skills to carry out the treatment safely.

If in correction and casting we follow completely natural movement of the foot and the treatment is done by a team of specialists, then the cast „does not hurt”, but for a short time it may be uncomfortable (different position of the foot and leg, immobilized in the cast). As a rule, it takes a child 1-2 days after the first casting for them to get used to the cast.

A child can definitely perform all the previous activities in a cast. Sometimes, as specialists, we laugh that there is no real possibility that a child in a properly applied cast would not be active and that we could forcefully „stop” them – we will not stop development and if some physical activity is to come or exist, it will come regardless of „obstacles”. In children with casts, we observe a full range of activities: crawling, turning, sitting, getting up and walking, running, doing somersaults or dancing. It is hard for us to imagine this, because as adults we carry within ourselves the belief (unjustified) that „we would be uncomfortable”. However, we must remember that this is our imagination, which is often not reflected in reality. And we give our child such an imagination.

Long leg or short leg cast?

Of course, physical activity depends on the type of cast applied. If we are dealing with a child up to 12 months old, we will choose a long cast for treatment, i.e. from the groin to the toes with the knee bent at a 90-degree angle. A long cast primarily stretches the contracted medial tissues of the foot better. At the same time, this cast will not slip off quickly. In the treatment of children over 12 months, we will consider applying a short cast: from the toes to the knee, due to the high chance that the child will soon start walking on its own. In this case, the use of a short cast will be a right and good solution.