These are some things that we learnt along the way. These tips come from advice gathered from other people, as well as our own discoveries during our experience. We would have appreciated knowing some of these things beforehand and are grateful for what other parents shared. We aren’t medically trained – these tips are practical advice for other parents – and although every baby is different, most of this should apply in general.
Bathing with the cast on
Soaking off the casts
The easiest way for us was to thoroughly wet some long adult size socks a few hours before and roll them onto the casts. At Alex’s normal bath time, we would sit him in his bath seat in warm water with some vinegar added (tip: vinegar helps to soften the plaster faster). Then, with his casts completely submerged, we squeezed them and started unravelling the bandage bit by bit. Do it carefully, if the bandage tears (it usually does at least once); you have to find the short bit and start working it free all over again.
By the time they were off, the entire bath was murky with plaster of Paris. We would bath him in fresh water, and then apply lots of moisturising cream all over. The exposed skin is quite red and sensitive when it comes out of the plaster and also quite flaky. Alexander would cry a bit when he came out of the bath until he was dressed and the skin covered up again. Just be as gentle and quick as you can and don’t worry about the flaky skin, it’s the skin that would normally be shed by exfoliation, but hasn’t had anywhere to go because of the plaster covering it.
Note: Dr Ponseti didn’t do it this way*, because it has to be done the night before the appointment. He liked to have the casts removed just before he applies the new cast so he could see exactly how the foot has reacted, with no chance for regression overnight. The morning of our appointment, we would soak Alex’s casts in a warm bath with a little vinegar added – a kitchen sink or basin works just as well if you only have a shower. Then we’d wrap the casts with damp towels and cover them with a plastic bag. The nurse would cut off the softened cast when we got to Dr Ponseti’s rooms and we would bath him in their sink, to get all the plaster residue off his skin and put baby cream on to moisturize his skin a bit.
*Apart from the tenotomy cast, which is removed three weeks later. We were home already and Dr Ponseti told us that we could just soak it off, it wasn’t necessary to have it removed by a doctor or nurse.
After casts are applied
Don’t be too concerned if a tiny baby’s nappy leaks a bit onto a cast. We would rub it off as best we could with a wet wipe and leave it. The cast will be removed again in a week anyway.
We were told to check Alex’s toes a few times after the casts were applied to make sure that there was enough circulation. The way to do it is to press lightly on the toes, they will go white, but as soon as you remove your finger they will return quickly to their normal colour. If they don’t, tell your doctor, the cast may be too tight
Clothing for plaster casts
During colder weather, we even found that tracksuit pants, and baby jeans, fitted over well, you can stretch towelling socks over the casts to keep the feet warm and dungarees are always useful. Remember that the casts are quite warm, so don’t overdress them. In warm weather, Alex would often just sleep in a vest; his legs didn’t need any covering other than the casts.
Clothing for the clubfoot brace
Also, changing a nappy without the poppers to open up the pants means pulling the pants down – and with your baby’s legs held out to shoulder width by the bar, that’s not easy. And a bonus for nappy changing with the bar on is that it’s so easy to hold it up, keeping both legs out the way. It took us a while to get used to holding two separate feet up again once Alex was out of his FAB fulltime!
Tip: When your baby is in casts, always roll up a towel and put under the knees, whether for sleeping or sitting. It stops the casts from putting too much pressure on their heels.
The same goes for the three months of fulltime FAB wear, although we found that people were usually more comfortable with this. They would comment that their nephew, niece, friend’s baby, or even themselves, had worn a brace for something as a baby. It doesn’t look as scary as plaster casts can, in fact it’s quite zooty looking with the little tasselled leather shoes and anodized red aluminium bar – we called it Alexander’s skateboard!
Once your baby is only in the FAB for night time and naps, then there are no more questions, because their feet look absolutely normal and with the Ponseti Method, there’s no scarring to make people ask what happened to their feet.
First days of FAB wear
For the first few days, play with the bar while it’s on their feet, hold it up in the air, bend their legs, show them what to do. They will pick it up quickly.
In our case, we would play with Alexander during the day and he would get frustrated with it now and again, but generally did ok. Night time was a problem for the first two nights; he would go to sleep as usual, but wake up every hour or two, feel the bar holding his feet, get very angry and start crying.
I discovered that if I put him lying on me, stomach to stomach, he could sleep comfortably a little longer and I think the body contact was comforting for his distress. By the third night, he was sleeping as usual and swinging his bar up and down easily. Then you have to watch out for it crashing down on your knees or arms, it weighs over 400 grams and I’ve been bruised a few times!
If your baby screams or gets upset for a longer time than expected, make sure that the shoes are fitted correctly, and that there isn’t any bruising or blistering occurring. We didn’t have this problem, but it can occur for a number of reasons and you need to tell your doctor so the reason can be diagnosed and dealt with.
Putting the shoes on
The way that worked for us is we either lay Alexander down with his bottle, or sat him on a lap – it depended on his mood. Make sure that the laces are nicely loosened up without them coming out of the holes – you can tie a knot in the ends if you’re worried about it, but we never did. Then loosen the strap all the way without taking it out of the buckle. If you are using Mitchell Ponseti brace, undo all the straps. Now you can put the foot in position, making sure that it is all the way back and in the shoe. Press down firmly on the instep and pull the middle strap tight first. Once the strap is buckled up you can do up the rest.
When you take the shoes off, the foot may look a little red in spots. We were told to use thin socks and two pairs for the first two days, which we did and it worked well. If the foot looks purple or blistered in spots, then either the heel wasn’t in properly and it’s moving in the shoe, or the foot may not be completely corrected and it’s uncomfortable for the baby. Check with your doctor as soon as possible if the marks don’t go away after a little while or it seems to be getting worse.
Making sure the shoes are on correctly
Another tip is to do the strap as tight as you can, then holding the shoe, gently pull up on the lower leg. If the toes move at the same time, in a marked way, then you know that either the strap is too loose, or the foot is not all the way in. In a very short time you’ll get used to it.