Background: Serial casting is a cost-effective process that increases function and safety without surgery, by placing one or both feet and ankles into a cast over a series of weeks. The cast will be applied and removed on a weekly basis. Each cast is molded with the ankle in a slight stretch into optimal joint alignment, thereby increasing the range of motion at the affected joints.
Indications for casting:
• Lack of range of motion in the ankle that does not improve with passive stretching
• Toe walking
• Flat arches as the result of tightness in the ankle
• Abnormal foot alignment
• Frequent falls due to lack of heel contact or toes dragging/catching on the floor
• Pain or discomfort in the foot or ankle
• Difficulty with walking
• Difficulty with gross motor skills, such as running, hopping, or jumping
• Difficulty putting on an orthotic/heel popping out of an orthotic
What happens during a casting session:
• The therapist assesses the muscle strength and range of motion.
• The child’s ankle is casted in a slight stretch with the foot in optimal alignment.
• Wedging may be added to allow for the child to walk in the cast with the shin perpendicular to the ground. A shoe is provided to cover the cast.
• The cast is removed with special equipment at the next weekly appointment, and a new cast will be applied.
• The casts are applied weekly until the target range of motion is achieved…approximately 4-6 weeks.
• The child is evaluated for orthotics/splints/braces, etc. to maintain the more functional position, prior to finishing the casting.
Precautions:
• The child should remain very active while casted. Staying active assists with the stretching of the muscles.
• The cast must remain dry. It must also stay out of sand.
• The skin may become itchy under the cast. Do not stick an item into the cast to scratch.
• Although unlikely, sores or poor circulation may result from a cast. Any child in pain should be promptly brought back to the clinic for cast removal and to have the skin checked for irritation.
Research:
• Children with limited range of motion require 6 hours of stretching to maintain their motion.
• With serial casting, sixty-six percent of children improved on gait, e.g. toe walking.
• All eight children in one research study gained motion in their ankles, decreased resistance to stretch, and stopped idiopathic toe walking.
