Frequently Asked Questions (FAQ)

Our FAQ’s are based on the Ponseti method because this is currently the most common way to treat clubfoot. This is also the method we are following with our son so it is the one we are most familiar with. If you are considering a different method, feel free to reach out to us and we can help you find information from our lovely community.
 
We are based in Australia so our information regarding costs and process of treatment might vary depending on where you live. The tips and tricks however should be universal to any child with clubfoot.
 
Our FAQ section is constantly being updated. If you have a question you want answered or you have a tip you would like to share, please get in touch with us so we can add it to our resources.
 
Disclaimer: The information on this website is based on personal experience and should not replace medical advice. I am not a doctor, I am just a parent of a child with clubfoot. The answers might not be applicable to your situation. Please see your medical treatment team for any concerns. 

The Casting Stage

 

 

When will we start casting?

 

This really depends on a number of factors and it is best to follow the advice of your doctor. Most children start casting within their first few weeks of life. Often your treatment team will recommend waiting a few weeks to allow you to establish feeding and adjusting to bub first. My son was premature, IUGR, and spent some time in the NICU after birth (due to medical issues unrelated to his feet). As he had a bit of a rough start, we did not start casting until he was 8 weeks old and he responded really well to treatment. Some children have other reasons for needing to start later and others will start when they are only a few days old, it depends on the individual child. Clubfoot is generally picked up at your 20-week ultrasound so you will already have had contact with your specialist team before bub is born with a treatment plan.

 

How do I know the extent of my child's clubfoot?

 
Your treatment team will give your baby a score on each foot at their first appointment and subsequently after each cast. This procedure is called the Pirani score. The total score varies from 0 - 6 with 0 being ‘normal’ and 6 being ‘severely abnormal’. Our son scored a 6 on both feet and he is now walking around and doing really well so don’t be disheartened if your child scores high. You can find more information on the Pirani score here.

 

Will my baby be upset? How can I help?

 
The first night is tough as bub is adjusting to casts but rest assured that our clubfoot babes are resilient and it won’t be long until this is their new norm. We were told many times throughout our journey that it’s tougher for the parents than the babies. I won’t lie - there are lots of tears as you and your baby adjust to life with casts but with a few simple tricks you will get through.

Each baby is going to be different but on our first night Raf wouldn’t go to sleep. The new casts made it awkward to cradle and soothe him. We decided to give him some pain killers for the first couple of nights as recommended by our doctor to help him get some rest.

During the day, we found the Boppy Lounger extremely helpful and used this a lot. Raf loved to be swaddled so we swaddled his arms but loosened the bottom to accomodate for his casts. We liked jersey swaddles but each baby is different so it’s a bit of trial and error. Popping a rolled up towel under your baby’s legs can also help relieve some of the weight and makes things more comfortable.

 

How do I prepare for the first casting appointment?

 

The first appointment can feel daunting as you don’t know what to expect. Rest assured it's a simple procedure and you’re right by your baby the entire time. In our experience the actual casting from start to finish takes twenty to thirty minutes. This might even be quicker if you have access to a clubfoot specialist. The main thing you want to do is create a familiar environment with smells and sounds from home. One of the hardest parts for us was keeping our son as still as possible when casting. Making him as comfortable as possible usually meant he would fall asleep in the appointment which helped our treatment team immensely as he wasn't kicking his legs around.

 

What to bring to casting:

1.  A white noise machine or phone with white noise app on it (and charger!)

2.  A bottle of milk. I found it helpful to feed bub while they are being casted and with some luck they will drift off to sleep. Our son had quite bad reflux so we used the Pigeon bottles as we found these to be the best. 

3. A familiar toy/blanket to comfort your baby. We used a Riff Raff toy for Raf from birth - you can use this link for free shipping. This toy plays white noise so was always a good back up if we forgot our noise machine.

4. Bath products for your second appointment onwards. Your baby has the option of a bath between taking off the old casts and putting on new ones each week. 

 

 

Bath time! How do I bathe my baby while in casts?

   

Your clubfoot cutie doesn’t really need a bath at this young age so don’t worry that you are missing out. They have lots of delicious natural oils on their skin so won’t suffer by not being fully emerged in a bathtub. A wipe down with a sponge is sufficient while casting. Remember that casts are changed once a week and you will be given an opportunity each week to fully submerge bub in the bath if you would like. During the week with casts on, we found it useful to turn on the heater in the bathroom and sit our son on a bath support on the counter top. We would give him a quick wipe down, baby massage, and moisturise before bed. If your baby has sensitive skin like Raf, we’ve found this QV baby moisturiser and Curash soap-free baby wash the best. 

   

Can I babywear during casting?

 

Yes! You can definitely still wear bub during casting, it might just take some adjusting to get used to it. I used both the Solly Baby Wrap (similar to this) and the Ergo 360. I found sling style wraps better during casting and the Ergo 360 better for boots and bars but it all comes down to personal preference. 
 
A great place to find information on this is the Facebook group Babywearing for Clubfoot Babies - there are a ton of recommendations and pictures on this website to help. You can even post a pic of you wearing bub and other clubfoot parents will help you get the fit just right.

 

Do I need special clothing for this stage?

 

I’ve heard some parents just size up and dress their child in any clothing but we found that onesies (especially those with zips) were really difficult when sizing up as they'd be too long and big.

Through casting, we found it essential to have little button up bodysuits as a core part of your baby's wardrobe. We would then put leg warmers over his casts and jumpers or shirts over his bodysuit depending on the weather. If it was cold outside, I would take a pair of my socks and cover his cast so his toes were kept covered and warm.

 

How can I help relieve wind for my baby?

 

I won’t lie - this was really tough for us. We had a windy reflux baby and when they’re in casts you cannot bicycle their legs as is usually recommended. We used Biogaia probiotics drops and found some relief but bub might just need lots of extra snuggles. We also found some success if we carefully and gently massaged his belly. 

 

Poo explosion all over casts! What do I do?

 

The dreaded poop explosion. Our son always chose to do this immediately after getting new casts and we quickly learnt to cover the top of the casts.

We kept it simple and just wrapped the top of the casts with a gauze bandage. We also had some leg warmers which we placed over the casts which helped. You could even cut the toes out of one of your pairs of socks and pop it over the cast. However, you’re dealing with a newborn and accidents happen so do not be disheartened if some poop gets on the casts. Just wipe down the best you can and let it dry. It’s an unfortunate part of the process.

 

Has the cast slipped? What do I do?

   

We were fortunate to never have a cast slip but I called my physio multiple times because I thought they had. Some doctors will recommend marking where your baby's toes sit right after casting. If they moved a fair way backwards into the cast in the coming days then you know there's a good chance they have slipped and its best to contact your physio to get checked.

With a whole week in between casting appointments, I would completely forget how they looked from one week to the next. I always took a picture of his toes from a few angles right after new casts went on so I could compare throughout the week. Sometimes the bottom of the casts would wear and disintegrate a tiny bit so I would see MORE toes but was told that was fine - only concern is when toes disappear. 
 

My child has irritated skin at the top of the cast, how can I help them?

 

We found that occasionally the top part of the cast would rub on our son's leg and cause redness. I got some makeup pads and popped them down the top of the cast to stop the rubbing - it worked a treat! If the skin becomes really irritated, it might help to grab some duoderm from the chemist and cut down a piece to stop further rubbing. 
 

What are the must have items for casting? Clothing? Car seat? Pram? Help!

 

Clubfoot babies are just like any baby so you will need mostly the same as you would with any baby. Don’t feel like you need to spend a lot of money. However, there are definitely some items I have found that made things much easier. I did a lot of trial and error and have tried my best to curate useful items for each stage of your clubfoot journey. For casting, I recommend the below:
 

• Leg warmers to wear over casts.
• Bath support to sit on your bench while giving bub a sponge bath. There are lots of different ones to choose from but anything with a soft net we found more comfortable for bub.
• We personally loved the iCandy peach pram. The bassinet is really spacious. This is a pricey pram that we were given by a friend so I’m sure there are cheaper options - I would just ensure you pick something on the larger side to accomodate for casts and braces. 
• We used the Britax safe-n-sound unity capsule during casting and upgraded to the Britax Millenia after 6 months. We got both from Baby Bunting. You don’t necessarily need both, we only needed the capsule because our son was born prem and very small so didn’t fit in the Millenia. We found the Britax brand particularly great for BNB because it was wider than other options.
• Jersey wraps are great for swaddling. I have also been told by other clubfoot parents that the Embe swaddle is fantastic for clubfoot.
• Riff Raff toy for comfort. Our son is nearly two years old and still loves his toy. It plays white noise and a lullaby so we got him used to this at home then brought it along to all our appointments and stays in hospital.
• An electric nail file is really useful for trimming toenails (and fingernails of course). As clubfoot kids feet are turned inward we found it difficult and a bit scary to try to cut our bubs toenails with traditional clippers.

Tenotomy Surgery

 

 

Will my child need surgery?

 
Each child is different so it is best to speak with your treatment team. However, the majority of children will need to have a tenotomy to lengthen their achilles after the completion of casting. 

 

When is surgery done?

 
Generally surgery is done once the foot has been corrected as much as it possibly can. My son needed 8 sets of casts (over 8 weeks) before he was ready for surgery.
 

I’m scared about the surgery, will my child be in a lot of pain?

 
Be kind to yourself and know it is all going to be ok. I was so worried about the surgery and lost hours of sleep panicking about the unknowns. I was blown away by how well my son handled the whole process. He was far better than I was. It was quick and my son barely seemed to notice! We would have been able to go home the same day as the procedure but needed to stay overnight for monitoring because my son was premature. There were no complications, we went home the following day and although bub was a little uncomfortable and needed pain relief, it wasn’t as bad as I imagined. 
 

What happens on surgery day?

The answer here will be different depending on your individual circumstance and treatment team. To give a rough idea, I will share our story from John Hunter Hospital in NSW.

We arrived at the hospital in the morning and bub was not allowed to feed after 7am (to be honest, holding off food while waiting to go into surgery was probably the hardest part). He went in around midday and one parent was allowed to go into the room while he was given a general anaesthetic. They gave him some gas on a little mask and he fell asleep immediately so they were able to then administer the anaesthetic. I was asked to leave the room (I was crying but reassured I would see him soon) and I went and sat with my husband in the waiting room.

Within the hour, I was called in to recovery where I got to be with him when he woke up. He woke up happy (and a bit groggy) and wanted to feed immediately. We then went to our hospital room for the night and it was business as usual. We administered some pain relief for our son and he handled the entire thing like an absolute champ.
 

Does my child have to wear casts after the surgery?

 
When bub comes out of surgery, they will be wearing their casts. This time, instead of wearing them for one week, they will usually need to wear these for three weeks. We put leg warmers over our sons' casts and wrapped the top with bandages to keep them as clean as possible. You can also put tights over them but you will need to size up to fit. We had to remove the casts a few days early because our son had a growth spurt so be sure to keep a close eye on the tops of the casts during this three week period in case bub grows out of them. We noticed our son’s thighs started bulging out of the cast, so much so that we couldn’t get the top of a pinky finger to slide into the top of the cast. That was a sign they were too small. 
 

I have noticed some blood on the cast after surgery, is this normal?

 
Please check with your doctor if this happens to you. We were lucky that this did not happen on our journey but we were advised to contact your team immediately if you notice excessive bleeding after surgery. 

 

Bracing Stage (Boots and Bar)

 

 

How long will my baby wear boots and bar? 

 

Most children graduate to their boots and bar (commonly referred to as bnb) after their surgery. My son wore his casts for three weeks after surgery and then he was fitted into his boots and bar. He initially wore them for 23 hours a day for 3 months. We then moved to 16 hours a day (nights and naps) and gradually reduced to 12 hour overnight wear. Each child is different depending on the severity of their condition so it is best to check with your treatment team when the time comes.

 

How do I prepare for the first appointment?

 
I found this appointment much easier than the casting. My husband and I were so excited to be moving to the next stage and no longer needing casts. The appointment was quick and simple. Our son had his casts removed then our treatment team popped him into his new boots and bar and showed us how to do it. We were shocked at how tight we needed to put the boots on but this is normal as long as you can fit the tip of your finger under the straps. I had some milk prepared for the appointment just in case and had some socks ready. We love the bamboo Bonds socks and have also heard positive things about Black Robin socks.
 

Will my baby be upset and uncomfortable?

 
It is definitely an adjustment for your little baby. We decided on the Mitchell boots and Ponseti bar for our son and he seemed confused as to why he could no longer move his legs independently. I won’t lie - he was quite uncomfortable and upset for the first few days. He needed lots of extra cuddles but after the first few days, he completely adjusted and didn’t mind them at all. He rolled over the first time in his boots and bar. He even crawled in them. He is now nearly 2 years old and more often than not will happily get his boots on before bed each night. 
 

Do I have to pay for the boots and bar?

 
This really depends where in Australia you live. When we lived in NSW, we had to pay for our boots and bar which was very expensive. We didn’t get anything back through Medicare or our private health insurance so it was totally out of pocket. We purchased ours from Massons Healthcare. After we purchased our first pair, we were lucky to have some generous parents from the Aussie Clubfoot Kids Facebook group send us their used boots. If you have to pay for your boots, I highly recommend jumping on this group first and asking if anyone has any spare to pass on. In most cases, someone will reach out with a pair they no longer need. Now that we live in Victoria the boots are free here.
 

What type of socks are best for bnb?

 
Bonds bamboo socks are amazing! We have used these our whole journey and to be honest haven’t tried anything else. These socks were recommended to us by other clubfoot parents and they have been great. In summer, I cut the toes off the socks to make them more breathable.
 

Do I need to buy special clothing for this stage?

 
Button up footless onesies were essential for us. This way we didn’t need to remove the boots and bar for each nappy change. We tried zips and found these did not work for us. Although everyone recommends zip ups for newborns, for a clubfoot kid go with buttons. Best and Less has a great range of affordable button up onesies that will work well.

 

My child has blisters on their feet from their boots, what should I do?

 
Unfortunately this can happen when they are adjusting to their boots. When we noticed any light rubbing, we got a special type of bandaid (compeed or duoderm from the chemist was great). We put this on for a few days and kept a close eye on things. Usually after a few days we noticed the redness had subsided. If the blisters become open and sore, it is usually recommended to give bub a few nights off to heal but it’s always best to check with your treatment team. If they are getting redness and rubbing underneath the middle strap, it is a good idea to buy some pressure saddles (you can get these from either your treatment team or privately through Massons Healthcare).
 

What do I do when my child starts refusing to wear their boots?

 
We luckily aren’t at this stage yet. However, we do our best now to create a positive experience when we put our son’s boots on each night. We sing to him, and yell out “yaaaay boot time” when we pull his boots out. He has a strong association between boots and sleep so we are lucky to have not had any major issues yet. We also read him some great kids books on clubfoot (Leroy’s Boots, One in 1000 and The Foot Book). 

 

What are the must have items for this stage?

 

• Bonds bamboo socks from Big W for wearing under the boots.
• Electric nail file for keeping toenails under control. Ingrown toenails can happen more often with clubfoot babes and we found an electric trimmer way easier and quicker to use than traditional clippers.
• We loved the Peg Perego Siesta high chair. It has great leg support so bub doesn’t have their feet dangling. The tray comes out easily too so it’s easy to pop bub in without taking off their bnb.
• We found the iCandy pram great because it had great wide support when wearing the bnb. I think any pram with an adjustable wide foot rest would work well.
• Footless button up onesies. These were a must for us. It makes it so much easier to change nappies while keeping the bnb on.
• Sleepsacks are fantastic. We personally loved the Ergobaby and Grobag sleepsacks and I tried a lot of different ones. I have also heard lots of positive feedback about the Embe swaddle. The bottom is wide enough to have space for the boots and bars. Make sure you have a look at the tog rating to get the right type for the climate you live in.
• The Baby Bjorn bouncer was recommended to me by another clubfoot mum and we loved it. It was great for both the casting and boots and bar stage. 
• Bar covers are really useful to help protect your furniture and you! Baby is often so busy moving around that you’re bound to get smacked with the metal bar at some stage. 

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