The foot was gradually moved into a corrective position while the plaster was setting until the child turned his or her eyes and “looked.” Correction of the foot always would stop before the point at which the child would begin to cry signaling distress. Under Brand’s direction, an infant with a clubfoot deformity was put to nursing while plaster of Paris was placed in single layers directly on the foot to be corrected. Once Brand relocated from medical school in England to India, he observed there that adults with clubfeet that had never been corrected still had supple joints. He began to understand that the initial benefits of forceful correction with “wedge casting” were often undone by deep tissue scarring and later tissue contraction, and was sure that there must be a way of correcting a joint deformity without such damaging force on the tissues and on the child. Serial plaster orthotic positioning or casting for contracted joints or soft tissues began with Paul Brand in his use of plaster casting of clubfeet in children. Through serial reapplication of the plaster cast or orthosis the tissue gradually elongates, resulting in correction of joint and soft tissue contractures and/or muscle-tendon unit tightness. Pathomechanics: Inevitability of GradualnessĬontracted joints and soft tissues can be remodeled and contractures corrected through the serial application of plaster casts or orthoses that hold the shortened tissue or joint at the end of its available length or range of motion (ROM) for a prolonged period of time.
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