They are changed frequently, each time repositioning the foot a little closer to normal. For the first two to three weeks, the casts are changed every week. Cast changes are then decreased to once every two weeks. Manipulation and casting may be distressing to the infant for a short period only, Scott said, but the baby soon settles once rewrapped and cuddled. Complete correction, if it happens, will occur by the time the child is three to six months of age.
Doctors differ widely in their opinions regarding the success rate of serial casting.
Some say the procedure works only five percent of the time, while some believe almost all cases of clubfoot, when treated early and correctly, can be corrected with conservative therapy. Barnes says serial casting works in 20 to 25 percent of cases, but this percentage could increase, he said, if more physicians were trained in proper manipulation and casting techniques. A well-intentioned doctor with inadequate training in serial casting can actually compound the deformity, he said, making further treatment difficult. Clubfoot patients should be referred to a center with expertise in the management of clubfoot. If all else fails If the foot is too resistant to allow for adequate correction, then surgery is performed to lengthen or release the tight or shortened tendons and ligaments, allowing them to be positioned in normal alignment.