| This advice concentrates on caring for babies and very young children, since treatment for clubfoot usually starts shortly after birth. Some of the hints and tips can, however be adapted for use with older children.
Health Issues
Watch out for symptoms that suggest that there may be a problem with circulation such as:
';A lot of swelling
';The toes turning blue or white
';The toes feeling icy cold, even when the child is warm
If you suspect circulation problems contact the hospital or your GP.
Following surgery blood sometimes oozes through the plaster. The stain is usually ringed with biro by the hospital staff and monitored for regular bleeding. If the wound starts to bleed after discharge, ring the stain yourself, adding the date and time and telephone the hospital or your GP for advice.
If there is a strong, unpleasant odour coming from the plaster and your child seems restless and feverish, contact the hospital or your GP immediately as the wound or a plaster sore may be infected.
If the toes disappear inside the plaster contact the hospital without delay because the foot is no longer being held in the correct position and also you cannot check the circulation.
Sometimes the plaster cracks and softens, often around the heel and ankle. Contact the hospital for advice as the plaster may need to be reinforced.
Caring for the Plaster
Try to leave the plaster open to the air for the first 24 hours to allow it to dry out quickly if you can do so without allowing your baby to get too cold. A new plaster cast is rough and flaky and will leave white powder on your clothes so wear something that won't get spoilt.
Babies quickly get used to the plaster but will be upset during the application and for a short time afterwards. Try to keep calm and reassure the baby.
If full length plasters are becoming damp try putting plastic popper or tie pants over the nappy for added protection.
Changing the nappy with a towel under the baby can help you to mop up spills quickly. If the plasters are regularly being wet during changes try putting plastic bags with elastic woven through the tops over the legs during change time. Never risk letting children play with the bags when not in use though as there is a danger of suffocation.
You will not be able to bath your baby during the plaster stage but you can fold a large towel into an empty baby bath, cover the plasters with the bags as before and sponge bath the baby. For babies up to the age of 3 months putting condoms over the plasters often works well.
The edges of the plaster are often protected by a water resistant tape called Sleek which also protects the skin from rubbing but it is still best to clean these areas with baby lotion or wipes.
Be careful about using talc as it can slip down inside the plaster and set into hard balls which irritate the baby's skin.
If the outside of the plaster becomes soiled it can be cleaned by wiping it with hydrogen peroxide or damping it slightly and rubbing with talc.
Strapping and Splints
Checking for the danger signs
Some swelling is normal but you need to watch out for symptoms that suggest that there may be a problem with circulation such as:
';A lot of swelling
';The toes turning blue or white
';The toes feeling icy cold, even when the child is warm
If any of these signs are present inform your doctor or hospital immediately
Caring for Splints
Strapping will be renewed at least once a week and tightened as often as necessary. You may be told to tighten it yourself between visits.
If so ask someone to help - one of you holding the child while the other applies the tape. Cut the tape into lengths before you start so that everything is ready and you can concentrate on holding the child still and applying the tape quickly. The new tape should follow the pattern of the tape applied by the staff at the clinic. You will only be tightening it, not reapplying it.
As strapping is renewed regularly cleanliness should not be a real problem. Try to keep it dry, taking special care when changing nappies, you could try making "wellies" from plastic freezer bags to pop over the strapping at this time.
If the skin becomes sore and rubbed try cleaning with surgical spirit and show the clinic staff at the next change. They may be able to position the strapping slightly differently, or pad the area to allow the soreness to heal.
Check whether you are allowed to remove the strapping or splints the night before the next appointment so that you can bath the child properly. This will depend on whether the health professional feels that the over-corrected position must be maintained at all times.
Clothing
Strapping
Clothes allowing easy access to the feet are best straight after the strapping has been applied so that it is easy to check the circulation. Once you are happy that all is well there will be no need for special clothing.
Splints
"Babygro" style sleepsuits that cover the feet are not suitable as the fixed metal bar of the splint causes problems. Many parents find that trousers with poppers down the legs are easier. In winter one-piece sleeping bag-style pram cosies work well.
Poor circulation to the feet at night time can result in disturbed nights. Check that straps and laces are not too tight and try using a sleeping bag.
Health Problems
Colic
If your baby seems uncomfortable it can be worth trying treating him/her for colic. Plasters seem to make colic worse because babies cannot draw their knees up to their stomach in the way that they normally would.
Skin Sores
These often appear around the edges of the plaster. Keeping the skin as clean as possible will help. Wipe the area with baby wipes and apply nappy cream at each change. For sores just inside the plaster wrap a wipe around a cotton bud to reach the area.
Socks or soft baby shoes will help avoid sores around the toes once the baby is moving around.
Sleeping Problems
Some babies have very disturbed sleep patterns during treatment. Try altering their position at the first signs of wakefulness and inserting a folded towel beneath the legs. Contact your GP if you are still having problems.
Care after plaster removal
If plasters have been in place for a long time the leg may look bruised and swollen. Leave free of clothing if possible and apply a little antiseptic cream from time to time.
Even after a short time in plaster the skin can be dry and flaky. Rubbing in a little baby lotion or baby oil will return the skin to normal, although do not do this if plaster is to be reapplied as this may make the baby's legs too slippery for the staff to hold.
If the plasters have been applied following an operation the wound will usually have healed and the thin red scar that is present will soon fade to a silvery line.
08/05/06
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