Serial Casting

Since its launch in 1992, the serial casting program has helped hundreds of children gain independence with standing and walking. The program is a collaboration between the physical therapy and orthotics teams to achieve the best possible outcomes for your child’s unique needs.

Our approach to treating toe walking includes a casting process, brace wear, exercises, and routine follow-up. When a child walks on their toes, our team’s goal is to make the ankle muscle grow longer through positioning and activity. We never stretch a child’s muscle because we believe our patients should be able to participate in serial casting comfortably. It should not be a painful process. Our program is also built to help children correct center of mass alignment issues. This is often a contributing factor to walking with weight balanced over the toes.

Our program has been successful for many of our patients. Our goal is to achieve long-term correction of range of motion, improvement in walking and to delay or prevent future surgery.


Each child is evaluated by a physical therapist and orthotist to discuss the program and determine the child's plan of care. The actual casting process can take anywhere from six to 16 weeks. Children are seen weekly for a two-to-three hour appointment where new casts are applied and they receive their home exercise program.

During serial casting, joints that are limited in range of motion are immobilized with a well-padded plaster and fiberglass cast. The casts are applied and removed on a weekly basis. With each series of casts, the affected joint or joints are gradually set in a more correct alignment until the desired range of motion is achieved. The casts provide a stable base of support while realigning joints, which allows us to strengthen muscles and teach children how to correct their center of weight for a more effective walking pattern.

We encourage children to participate in their typical daily activities while wearing the casts. Regular movement helps strengthen the muscles they need for correct walking alignment. We also ask that children complete at least an hour a day of standing or walking exercises. This hour can be divided into smaller time periods. Your physical therapist will give you specific exercises.

The number of weeks in the casting process varies because each child’s muscles change at different rates. Given that the range of motion continues to improve, our team will perform weekly cast changes until the goal range is achieved. However, if there are no changes over a two-week period, then we will finish casting and move on to the next steps.

After the child has completed the casting process, they will be fitted with day braces and night braces. The AFOs (ankle foot orthoses) brace the lower limb and maintain the alignment that was gained during the serial casting process. Children will also continue doing their standing or walking exercises, with additional ankle strengthening activities. Once their new walk becomes natural, we will gradually wean them out of the day braces. They will need to continue to wear their night braces through growth to maintain range of motion and avoid the need for re-casting.

Post-casting follow-up visits allow the team to monitor your child’s progress. Visits are scheduled every three months to assess range of motion, and to advance the exercise program. Children who complete the full casting and post-casting program have significantly greater long-term success in maintaining joint alignment with a corrected walking pattern.

Make an Appointment

Each child and family who has been referred by a physician will have an initial evaluation with the team. Casts are not applied during this visit. If your family decides to proceed with the program, additional prior authorization from your insurance company must be obtained for serial casting and orthotic management. Our team will assist your family with this process.

All appointments can be made through the Orthotics Department at 312.227.6210.