# A nurse is caring for a 3-month-old infant with congenital clubfoot who is being treated with the Ponseti method. The parents express concern about the casting process. What is the most appropriate nursing intervention?

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> subject: Child Health

## 문제

A nurse is caring for a 3-month-old infant with congenital clubfoot who is being treated with the Ponseti method. The parents express concern about the casting process. What is the most appropriate nursing intervention?

## 보기

1. Educate parents about proper cast care and signs of complications to monitor **✔ 정답**
2. Recommend delaying treatment until the child is older and can cooperate better
3. Suggest switching to surgical correction as it provides faster results
4. Advise parents that casting is unnecessary if they perform daily stretching exercises

**정답: 1**

## 해설

Educating parents about cast care and monitoring for complications is essential for safety and treatment success with the Ponseti method. Other options are inappropriate as they delay treatment, suggest unnecessary surgery, or omit critical care.

## 심화 해설

Correct Answer: 1

Understanding the Ponseti Method and Parental Concerns

The Ponseti method is the gold-standard, non-surgical treatment for idiopathic clubfoot. It is a two-phase process: an initial corrective phase involving weekly gentle manipulation and serial casting, followed by a maintenance phase using a foot abduction brace (FAB) to prevent relapse [1]. When parents express concern about the casting process, the most appropriate and evidence-based nursing intervention is to provide targeted education. This directly addresses the knowledge gap that often underlies parental anxiety.

Why Education is the Priority Intervention

The scoping review by Nantalaga (2026) highlights that non-adherence to the treatment protocol, particularly the FAB, is the "principal modifiable driver of relapse" [1]. While this review focuses on the bracing phase, the foundation for adherence is built during the initial casting phase. The barriers and facilitators identified in the study, such as a lack of understanding of the treatment rationale and practical challenges, are first encountered when serial casting begins. By proactively educating parents on proper cast care and the signs of complications to monitor, the nurse directly builds the parental knowledge and self-efficacy that are critical for long-term treatment success. This intervention transforms passive worry into active, informed participation in their infant's care.

Analysis of Incorrect Options

- Option 2 (Recommend delaying treatment): This is incorrect and harmful. The Ponseti method is most effective when initiated early, ideally in the first few weeks of life, when the ligaments and joint capsules are most pliable due to maternal hormones. Delaying treatment allows the deformity to become more rigid, making correction more difficult and potentially less successful. The parents' concern should be addressed with support and education, not by compromising the therapeutic window.

- Option 3 (Suggest switching to surgical correction): This is incorrect. The Ponseti method is the established gold-standard treatment because it is less invasive, more cost-effective, and yields better long-term functional outcomes than primary surgical release [1]. Surgical correction is reserved for cases where the Ponseti method fails or for recurrent, rigid deformities. Suggesting surgery as a first-line alternative due to parental anxiety about casting is not aligned with current best-practice guidelines.

- Option 4 (Advise parents that casting is unnecessary): This is factually incorrect and dangerous. The serial casting phase is an indispensable component of the Ponseti method. It is the mechanism by which the foot deformity is progressively corrected. Daily stretching exercises alone are insufficient to correct the bony malalignment and soft tissue contractures present in clubfoot. The casting phase is what makes the subsequent bracing phase effective in maintaining the correction [1].References (research sources)

- [1]Barriers, facilitators and interventions for foot abduction brace adherence in the Ponseti management of idiopathic clubfoot in low- and middle-income countries: a scoping reviewResearch articleNantalaga KC. (2026) · DOI: 10.21203/rs.3.rs-10037868/v1

## 임상 시나리오

Ponseti Method: Parental Education for CastingBuilding Adherence from the First Cast
The Ponseti method is the gold-standard treatment for idiopathic clubfoot, starting with serial casting in early infancy. The principal modifiable driver of relapse is non-adherence to the bracing protocol, a foundation laid during the casting phase.

When parents express anxiety, the priority is targeted education to transform worry into active participation. Teach proper cast care (keeping the cast clean and dry) and signs of complications to monitor, such as impaired circulation, skin breakdown, or excessive crying.

CautionNever advise delaying treatment or substituting casting with exercises. The corrective phase requires weekly cast changes for 4-6 weeks. Delaying reduces success rates due to decreasing ligamentous laxity.

## 핵심 개념

- **Clubfoot (Talipes Equinovarus)** — Congenital clubfoot. It is a congenital foot deformity where the ankle turns inward and the sole of the foot faces inward.
- **Ponseti Method** — This is the standard non-surgical treatment for congenital clubfoot, which includes daytime casting, minor tenotomy, and bracing.
- **Serial Casting** — Serial casting. This is a treatment process where the foot position is gradually corrected each week with a new cast applied.
- **Tenotomy** — Tenotomy. In the final stage of the Ponseti method, this is a procedure where the shortened Achilles tendon is released through a small incision to complete the normal positioning of the foot.
- **Foot Abduction Brace** — Foot abduction orthosis. A device worn long-term after cast treatment to prevent recurrence, maintaining the foot in an outwardly spread position.

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