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, Dr. Scott says, but the baby soon settles once rewrapped and cuddled. Complete correction, if it happens, will occur by the time the child is 3 to 6 months of age.
Doctors differ widely in their opinions regarding the success rate of serial casting.
Some say the procedure works only 5 percent of the time, while some believe almost all cases of clubfoot, when treated early and correctly, can be corrected with conservative therapy. Dr. Douglas Barnes, assistant chief of staff at Shriners, says serial casting works in 20 to 25 percent of cases, but this percentage could increase, he says, if more physicians were trained in proper manipulation and casting techniques. Physicians with limited experience should not attempt to correct clubfoot with manipulation and casting. A well-intentioned doctor with inadequate training in serial casting can actually compound the deformity, he says, making further treatment difficult. Clubfoot patients should be referred to a center with expertise in the management of clubfoot.