Don’t take them off!

Is it okay to remove the cast a day before the next appointment? It might seem obvious, yet parents often write to us saying that the doctor told them to take the cast off a day before the new one is applied. So what’s the right approach?

HOW SHOULD IT BE DONE?

During the casting phase of treatment, which is the first stage of the Ponseti method, the cast should be removed on the same day that a new one is applied.

If you’re not familiar with what PROPER TREATMENT should look like, take a moment to review the correct treatment process — it may help you avoid treatment failures.

The Ponseti International Association (PIA) states that:

(…) DO NOT SOAK OR REMOVE the cast the day before your appointment.

Many parents tell us that their doctor instructs them to remove the cast at home a day before the next visit, explaining it with reasons like: “the leg needs to rest” or “the child needs a proper bath.” We’ve heard countless explanations — none of which actually justify removing the cast early. What’s even more surprising is that some large medical centers treating clubfoot still suggest doing this.

We want to make this clear and unambiguous:

IF A DOCTOR TELLS YOU TO REMOVE THE CAST A DAY EARLY WITHOUT A TRULY IMPORTANT REASON –
IT MAY MEAN THEY ARE NOT SUFFICIENTLY FAMILIAR WITH THE PONSETI METHOD.

An exception applies only when the cast needs to be removed due to swelling, slipping off, or circulation problems (when the cast is too tight) – that is a valid reason.

WHY NOT?

Removing the cast a day before the next visit is not okay — and you’re absolutely right to question it. The Ponseti method is based on maintaining continuous correction.

Overnight, the foot may partially — or even completely — revert to its incorrect position.
Such practice prolongs the overall treatment, increases the risk of relapse, and results in incomplete rather than full correction. And when the correction is only partial, the risk of re-treatment rises — which is more expensive, takes longer, and comes with additional challenges.

Removing the cast a day before applying a new one makes no sense and has no medical justification.

Studies have shown that:

(…) removing the cast just before the new cast is applied significantly decreases the number of casts required for correction and shortens the length of treatment.

Dr. José Morcuende | Dr. Gaston Terrazas-Lafargue

So if a doctor suggests removing it a day before, it’s worth politely insisting that it should stay on until the visit. The foot should never remain without a cast overnight during the casting phase.

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MEDICAL RESEARCH & MEDICAL SOURCES

1. Terrazas-Lafargue G., Morcuende JA: „Effect of cast removal timing in the correction of idiopathic clubfoot by the Ponseti method.”