Serial Casting

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BDI Playhouse Children’s Therapy is excited to offer a variety of dynamic and serial casting options to address toe walking (equinus gait pattern), club foot, club foot relapse, and a range of motion limitations and poor alignment of the foot and ankle.

The casting process is a noninvasive treatment technique using a cast or series of consecutive casts with a goal of improving range of motion and mobility and improving foot alignment.

Most casts are applied using a flexible cast material or plaster that can be removed in the home after 4-7 days and most children walk on the cast and can participate in reasonably typical activities during the casting process.

Goals of Casting:

  • Improve range of motion
  • Prevent complications from changes in bony alignment
  • Improve alignment for future orthotic use
  • Increase the level of function
  • Prevent chronic skeletal issues

Therapists providing serial casting:

  • Have extensive training in lower extremity casting, specialty casts for foot alignment and corrective casting to promote optimal foot positioning and mobility
  • Adapt treatment based on each child’s needs
  • Offer experience in functional movement, gait analysis, range of motion, and collaboration with all members of the healthcare team

Conditions that can be addressed with serial casting:

  • Cerebral Palsy
  • Idiopathic or sensory equinus gait or “Toe Walking”
  • Duchenne Muscular Dystrophy
  • Spasticity
  • Decreased range of motion
  • Traumatic Brain Injury
  • Club foot or Club foot Relapse
  • Charcot-Marie Tooth
  • Metatarsus adductus
  • Excessive pronation and Navicular drop

Frequently Asked Questions:

What is Serial Casting?

Serial casting is the conservative clinical process of applying and removing a series of lightweight casts on a child’s arm(s) or leg(s) to improve the alignment, range of motion, and functional mobility of a joint that has limited mobility and/or is not properly aligned.  The casts are applied by a team of physical or occupational therapists who are highly trained to assess each child and fabricate the casts to not only stretch the soft tissues but to maximize the alignment of the joint and optimize its mobility and function.  In most cases, soft semi-flexible casting material is applied over stockinette that is padded to protect bony prominences and encased in a layer of cotton wrap.  The joint is carefully positioned to maximize alignment and gently stretch the soft tissue and maintain it in that posture throughout the casting process.  The child wears and walks on the cast for several days (typically 4 days on and 3 days off) and then a series of casts are applied in the same sequence for several weeks until the joint position and function is optimized.  Serial casting is also appropriate to reduce spasticity and help prevent contractures and deformities.

How many casts will be needed?

Because each child and situation is unique the results vary and it is almost impossible to tell exactly how many casts will be needed.  On average, the typical length of time a child will be in casts is 6-12 weeks but measurable improvements are often made in just a few casts.  If a child is not bearing weight consistently on the joint or has neurological factors that cause increased muscle tone or tightness the casting process can be longer. 

How is the cast removed?

In most cases, soft flexible casting material is used and this can be removed quite easily by the family at home.  If a child is likely to try to convince a parent to remove the cast early or thinks he/she can do it him/herself without permission we will make an appointment to remove the cast in the clinic.  In rare cases, a more rigid casting material is indicated and this will require removal with a cast cutter or “Tickler” with a blade that uses vibration to generate the force needed to buzz through the material

What happens after serial casting?

Dynamic Serial casting is a modality designed to improve and maximize alignment, joint range of motion and mobility but it does not take the place of skilled physical therapy intervention and a good home exercise program.  In many cases braces or orthotic appliances are still worn to help keep the joint flexibility that has been gained.  Daytime orthotics are often recommended for a period of time until the desired strength, mobility, and gait pattern is achieved and night splints may also help maintain these gains.  Many children have developed undesirable gait or movement patterns in the past and therefore it is important to continue therapy after serial casting to develop and strengthen new patterns and to maximize and maintain these gains.  These are important conversations to have with your treating therapist as well as the casting specialist.


Great Feedback from Great Families

One of the best things that they have done for him is serial casting. BDI stepped out to develop a serial casting program at the clinic. This was a huge undertaking of training, planning and cost. So much so, that you normally only seen this done at hospitals. However, their commitment to do this, even at cost to them, shows how much they value the success of each patient. Due to serial casting and the therapy that surrounded it, my son regained his ability to stand flat footed and stay stable, something that he had not been able to do since the age of two. He can now run and casting has also prevented or at least delayed the need for surgery to address his needs.”

Getting Started With Serial Casting

Still not sure? Learn more about whether your child needs therapy here