It is essential and of the utmost importance that you watch for slipped casts. Even the slightest slip can cause a secondary deformity called complex clubfoot.
Complex clubfoot is created from improper casting and the leading cause of complex clubfoot are slipped casts. One slip is a mistake. The doctor or caregiver must modify their treatment protocol and methods. Following the guidelines from Dr. Ponseti's Modified Method can solve this. It is of utmost importance that the caregiver modify their methods and cast the foot according to the modified Ponseti Method.
Do not leave baby's foot inside a slipped cast for any length of time.
If there is a slip, the cast must be removed immediately. Not ASAP, not when you can get to it, and not when the doctor finally calls you back to approve removal. It must be removed immediately to prevent damage.
For plaster casts, you will need to soak it off.
For fiberglass casts, they can be unrolled. Just find the end of the tape and begin pulling.
**Do not remove a cast that has not slipped.**
If you suspect a slip, check your pictures from right after the casting was complete. Check the lines you drew on the toes. Take new pictures to compare to the previous ones. And consult others to see if they think the cast has slipped. Remember that the batting in the cast can become compressed over time, or it can be come frayed and appear to be different than before. The plaster or fiberglass cast edge is the point that you need to compare to, not only the batting/padding and especially if it has changed at all. Make sure to draw these lines on the toes right away at your casting appointment.
My daughter had 5 slips. All after the tenotomy.
The white of the cast is right after, the blue is the cast wrapped in sports wrap with the slip. In hindsight I wish I would have taken it off right away, but when I called it was after hours and I don't think they really believed it was a slip so instructed me to keep it on until morning when they could review the photos. I was confused, because she had just had the tenetomy a few days prior, and I didn't want to mess that up. But when we finally saw another doctor she had to have 7 sets of casts with the new doctors to fix her complex foot enough to even go into boots. And the hope is once she is weight bearing it will correct further on its own. And she still may need a repeat tenetomy. So I should have just taken it off right away, even with just having the tenetomy.
Slipped Cast 1 Before - Post Tenotomy Cast
Slipped Cast 1 After Slip - Post Tenotomy Cast
