A Novel Technique to Remove Plaster Ponseti Clubfoot Casts
From Lisa DuShane
Serial Ponseti-style plaster of Paris casts are considered the gold standard treatment for clubfoot in infants. In conjunction with cast application, weekly cast removals are a necessary part of treatment, predisposing this patient population to cast saw injuries. Extensive research and education have been devoted to eliminating iatrogenic cast saw injuries. However, decreasing experience and familiarity with cast saws lead to a 1-2% incidence rate of cast saw burns or abrasions. While alternatives such as soaking the cast off or using protective strips are available, these lead to interruptions in clinic workflow and failure to successfully treat clubfoot, respectively. We present a technique which successfully and safely removes Ponseti-style plaster of Paris casts by perforating only the convex side of the cast, using superficial partial thickness scores, and a large cast spreader. The proposed technique can reduce cast saw injuries by potentially 50%.