Congenital Talipes Equino Varus – Ponseti Plaster of Paris – Leaflet 2

Patient Experience

  • Reference Number: HEY1475-2024
  • Departments: Paediatrics, Therapies
  • Last Updated: 31 July 2024

Aim of Plaster of Paris (POP)

The aim of the plaster casts is to gradually stretch out the soft tissue on the inside of your baby’s foot.  This will allow the foot to be moved (stretched) outwards to rest in a neutral position.  A plaster cast is applied from the toes to the top of the thigh. This is changed weekly to gradually correct the foot.  The casting is not painful but during application of the plaster your baby may be unsettled due to being held still. Once the plaster is dry (5 minutes) the baby usually settles again.  However, you may wish to try giving a bottle during the application or bring any favourite toys to help keep your baby settled.  Your baby’s nappy will need to be removed during the procedure to enable the POP to encase the thigh.

Care of the POP

Bathing

The POP needs to remain dry at all times.  Therefore, unfortunately your baby needs to be washed rather than having a bath.

Nappies

You will need to change your baby’s nappy frequently to avoid soiling of the plaster.  Disposable nappies with elasticated legs usually work well.  Try to fit the leg of the nappy above the top of the plaster, to avoid urine leaking under the plaster.

Position

Your baby’s toes need to remain at the end of the plaster at all times.  If you feel they have moved backwards in the POP then it may begin to cause pressure and rub and so needs to be removed. Please contact the Ponseti team during normal working hours or attend the A&E department with this leaflet.

Pressure

Although great care is taken when applying the POP, there is still a chance that the plaster may rub which can cause damage to the skin. Your baby may be a little unsettled once the plaster is applied as the foot is in a new position.  However, this should settle well within a couple of hours and the baby can usually be comforted during this time, therefore if your baby can not be settled and is more distressed than usual for longer than a few hours it may be that the plaster is rubbing so please contact the Ponseti team during normal working hours or attend the A&E department with this leaflet.

Circulation

On very rare occasions, the plasters may restrict the circulation therefore it is important to check the colour of your baby’s toes each nappy change. If you gently press on your baby’s nail the pink colour should return straight away.

If you have any concerns, please contact the Ponseti team during normal working hours or attend the A&E department with this leaflet.

Removing the Plaster Cast

The initial and subsequent POP remain on for one week at a time.  On the day of your appointment, you will be able to give your baby a bath and soak the POP for around ten minutes. Once your baby is dry wrap the POP in cling film and then dress as normal prior to coming into the hospital. The physiotherapists will then remove the POP in clinic with scissors. There will also be opportunity to weigh your baby in the clinic.

Your babies’ foot position will be reassessed by measuring range of movement, completing the Pirani score and possibly taking photographs.

The POP will then be reapplied with further correction of the foot/feet. It may be useful to bring a change of clothes to take your baby home in as they can get damp from the wet plaster. The series of plasters usually takes approximately 4 to 6 weeks to achieve good correction depending on the severity and age of your baby.

Additional Information

The POP only has a thin layer of padding underneath which may be important information if the cast needs to be removed by A&E.  If you need to attend A&E please take this leaflet with you.

 If the plaster does need to be removed, please contact the Ponseti team as soon as possible to discuss re-application of the plaster.

Please take care that nothing is poked down the cast (particularly by siblings), if there is any suspicion that this has occurred please ring the Ponseti team during normal working hours or attend the A&E department with this leaflet.

QR code to open leaflet