Removing Ponseti Casts Without the Use of the Saw

Pre-soaking Casts

Try to start the pre-soak at least 1 hour before coming to clinic.

• Put a cloth (cotton tea towel or muslin) in water to soak o It helps to fold the cloth
• Put a dry towel under the leg in cast
• Fill a jug/small container with warm water
• Pour warm water very slowly onto the cast and rub all over
  • This gets the softening process started without taking it too far
  • The outside of the whole cast should be very damp
•  Take the cloth out of the water, don’t squeeze and immediately wrap it around the
  leg in cast.
  • It needs to be really wet to work well
• Wrap clingfilm around the cloth and cast
• Keep it all in place by putting the leg into a bag and tie the bag around the top of the
  cast.

Bathing in clinic

Fill a baby bath with warm water to cover the casts and allow the baby and casts to soak for 10-15 minutes with gentle squeezing of the casts to allow water to get between the layers

Removal of cast

Method 1: Use of the plaster knife – this is a safe method with care and time.

• Start at the top of the leg
• Cut at a 45 degree angle
• Where you can, put your own fingers between the baby and the knife
• Do not pull undercast padding away until all cast is cut
• Continue to wet cast as you cut through to facilitate softening of plaster
• Ease the cast material open as you go
• The last bit around the foot can be moved with gentle wiggling

Video available on request from naomi.davis@mft.nhs.uk

Method 2: Unwinding the plaster.

• Leave a nubbin of plaster after each roll is finished to facilitate finding the end to
  start unwinding
• If nubbin is not available, make small cut with plaster knife to fashion an end to start