Our Clubfoot Journey: Baby’s First Cast

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“Here’s your baby boy!”

After an incredibly long labor, those words echoed so beautifully in my ears.

What to know when your little one is born with a clubfoot; getting their first cast | ourbeautifulfeet.com
Welcoming a #clubfootcutie

I cannot express in words the joy at seeing Little E for the first time. Every single part of him was absolutely perfect. From the tuft of crazy long hair on the back of his otherwise bald head to each and every tiny fingernail. And yes, even his clubfoot. Just perfectly precious. <3

Now I’m not saying that his clubfoot was fine just the way it was. It is a deformity and it does need to be corrected so he can run and jump and play. What I am saying is that, when your little one joins you in the outside world, you will be so madly in love. His or her beauty will far outweigh that precious, crooked little foot (or feet).

Missed the first part of our clubfoot journey? Read it first, and then come back!

Preparing for your #clubfootcutie's first cast | ourbeautifulfeet.com
Handling Your Baby’s First Cast

After all the craziness that happens right after delivery (family coming in, moving to a postpartum room, the overload of information from the nurse, the first few diaper changes and spit up episodes, trying to nurse the first few times…), I finally had a bit of quiet time to think about his little foot.

The ultrasound specialist and my midwife told me that a doctor would come in and consult with us when Little E was born. I made sure to double check on that the next time the nurse came in. She informed me that both a pediatrician and a physical therapist would be coming to evaluate him.

The physical therapist arrived first. After examining Little E, she told us that some babies only need a bit of physical therapy to correct the positioning of their foot. However, our little one’s foot was severe enough that we would need orthopedic treatments.

The pediatrician confirmed this when he stopped by. (After giving our little one an otherwise clean bill of health…yay!) He told us that the nurses would arrange our first appointment with the orthopedic pediatrician within the first week of Little E’s life, during which he would receive his first cast.

I remember (through the haze of all my other emotions and hormones) feeling sad that my son’s precious little leg and foot would be hidden from me soon.

Little E was born on a Thursday evening. Our appointment with the orthopedics department was on Monday.

I took extra care and effort to play with and admire his cute little right leg and foot during those first few days.

When Monday morning came, we waited anxiously in the waiting room for about 30 minutes before the doctor could see us.

The doctor we were scheduled to see was a specialist in the Ponseti method. Dr. B even got to study with Dr. Ponseti himself! She did an amazing job explaining the diagnosis and the treatment process to us.

There seem to be a number of variables that contribute to the deformity. The tendons are often too tight, causing the foot to turn in. This can also cause a couple bones in the foot to catch on each other, making it impossible for baby to straighten his foot. Some doctors even think the problem actually starts way up in the thigh!

They used to do surgeries to correct clubfeet. But Dr. Ponseti found that these surgeries often had detrimental side effects. He used his experience in the Spanish Civil War to design a treatment plan consisting of casting, braces, and manipulations. His treatment has now become the golden standard of clubfeet treatment!

Dr. B explained to us that Little E would go through a series of manipulations and casts (to hold the manipulation in place.) Casts stayed on for a week and, depending on how his foot responded, he would have anywhere from 4-8 casts.

Once the doctors were happy with how his foot was coming along, they would determine if he needed a tenotomy. You see, she informed us, more than 90% of babies still need a small surgical procedure to allow them to pull his foot upward (an important part of walking). If he did need a tenotomy, he would receive the procedure in clinic and then wear one final cast – this one for four weeks instead of just one.

After all the casts were finished, he would switch over to the Ponseti bar. This is a brace that uses boots and a bar to keep his feet rotated out. This prevents the deformity from coming back. Dr. B explained to us that Little E would wear this brace 24/7 until he could pull to a stand, and then he would need to wear it while sleeping until he was 3-5 years old, depending on his progress.

After all these explanations she asked if we had any questions.

Our major concern – does all this really not affect his motor development? Would he really learn to roll over, crawl, and walk as fast as other babies? Wouldn’t the cast harm his growth? Wouldn’t the brace harm his ability to move around?

Her reply was – “This is why we do it when their babies!” Babies are very malleable and adaptable. “In fact,’ she said, ‘I’ve even seen babies learn to walk with the boots and bar still on their feet!” It’s very rare that after this method a child would need physical therapy or other intervention to help with their motor development.

Once all our questions had been answered, it was time for Little E’s first cast.

Hubby and I undressed him and then we swaddled his top half up to keep him still and calm. Dr. B had us stand on the other side of the bed (near his head) to help calm him and so we could watch what they were doing.

She had a medical student with her, and she talked him through the manipulation of his foot.

She told us that in this first casting, they were going to correct the plantarflexion (big word alert!). This meant that his foot was pointing downward, and they were going to work on getting it to a flat position. Then, once this was fixed, they would start focusing on turning his foot away from the medial line (meaning that his foot was turned in towards the middle of his body, and they would work on turning it out).

For an explanation of the different problems in a clubfoot and the manipulations, check out this link.

As I leaned over the bed and pet my sweet baby’s head, I was amazed at how he didn’t even cry! He just stared up at the ceiling and sucked on my husband’s finger.

I, however, was holding back tears the entire time. Even though it didn’t seem to be hurting him at all, it still broke my heart that my little one needed a full leg cast (that’s right…they put it all the way up to hold the knee in place, too. Also, babies can slip out of casts that are below their knee.) only four days after he was born!

Once they finished up, the cast was massive! It seemed so heavy, and it looked at least twice as big as his leg itself. Again, Little E didn’t seem to mind too much. He was just taking it all in.

Dr. B gave us her card and told us to call her if we had any questions or concerns. She told us to check the circulation in his toes by pressing on his toe…if its circulation was good it should go right back to pink after you press on it.

She informed us to remove the cast right away and bring him straight in if his toes ever showed signs of poor circulation.

On the topic of removing the cast, we were informed that it usually works best for mom and dad to take the cast off at home the night or morning before their next casting appointment. This makes the appointment shorter and avoids having to use the cast saw to remove the cast.

They made his cast easier to remove by leaving it rough, rather than smoothing it out, and by creating some little knobs to start us off. All we had to do was soak it in some water and then unwrap it. Sounded easy enough! (To find out if it was, check out Part 3 of our journey.)

That evening, Little E finally showed signs of not enjoying his newly acquired companion. He was very fussy from about 5 pm through the next day and night.

By Wednesday morning, however, he had pretty much grown accustomed to it. He would still fuss sometimes if it was in a weird position or if it bumped into something, but overall he was back to his normal self.

He adjusted to the cast much better and more quickly than hubby and I were expecting.

We adjusted to it, too. In fact, it came in handy during diaper changes, as it actually made it easier to keep his foot out of the way. When dressing him, we found out we could use pants that were one or two sizes larger so they could fit over his cast.

There were still times though, especially during late night feedings that first week, that I found myself crying. Again, Little E wasn’t upset by it at all, and it didn’t seem to hurt him. But it still broke my heart to see my tiny little baby in such a huge cast.

I was angry at the existence of deformity and fallenness in the world. And in that first week, I kept asking God why. Why did my little boy have to go through this? It seemed so unfair.

But the Lord reminded me that He understands suffering and pain, and He is present with us in our suffering. When Christ entered into our world, He joined us in everything (except sin). He understands pain, illness, struggles, injustice, sorrow, and suffering. He is truly God-with-us.

The first week flew by! Before we knew it, it was time to take that first cast off. But that’s a different story for a different time. Find it in Our Clubfoot Journey Part 3!

Again, one thing that helped my hubby and I so much was the support of other parents who had gone through this before us and those who were going through it at the same time as us. There are many clubfoot support groups out there. One of my favorites was through BabyCenter.

Leave a comment below about your own clubfoot journey, or leave a question and I’ll do my best to answer it!

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