Cast Removal by Soaking Reduces Infant and Parental Anxiety Without Affecting Clinical Outcomes in Ponseti-Treated Idiopathic Clubfoot: A Prospective Controlled Trial.

Background: Cast removal is an essential but often stressful component of the Ponseti method for idiopathic clubfoot. The impact of different cast removal techniques on infant stress, parental anxiety, and treatment outcomes remains insufficiently explored. Methods: This prospective, quasi-randomized controlled trial included 84 infants with unilateral idiopathic clubfoot treated using the Ponseti method. Patients were allocated to cast removal by oscillating saw in the outpatient clinic (Group 1, n = 42) or by soaking and peeling at home prior to clinic visits (Group 2, n = 42). The primary outcome was the number of casts required to achieve correction and readiness for percutaneous Achilles tenotomy. Secondary outcomes included infant crying time, maximum heart rate during cast removal, parental anxiety assessed using the Short State Anxiety Inventory Scale (SAIS), cast removal time, hospital stay duration, and cast-removal-related complications. Results: There was no significant difference between groups regarding pre- or post-treatment Pirani and Dimeglio scores or the number of casts required (p > 0.05). Infant crying time, heart rate during cast removal, and parental anxiety scores were significantly higher in the oscillating saw group (p < 0.001). Cast-removal-related complications were more frequent in the oscillating saw group (p = 0.003). Conclusions: In this study, home-based soaking and peeling provided clinical outcomes comparable to oscillating saw removal and was associated with lower infant distress markers, lower parental anxiety scores, and fewer observed cast-removal-related complications. These findings suggest that soaking and peeling may represent a family-centered alternative for selected families receiving appropriate instruction.