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. 

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. 

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, which often are contributing factors to walking with their weight balanced over their 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. 

Approach

Our approach to treating toe walking includes a casting process, braces, regular exercises and follow-up.

During the serial casting phase, 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 extend over the child’s toes to provide a stable base of support while realigning joints, allowing muscles to strengthen and teaching children to correct their center of weight for a more effective walking pattern. Our physical therapists work very closely with our orthotics team to develop the casts and the braces our patients wear. A unique aspect of our program is that physical therapists and orthotists work together with the patient and have a shared understanding of the patient’s unique needs.

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

There is no typical amount of time for the casting process because each child’s muscles change at different rates. As long as the range of motion keeps improving, we’ll continue to do weekly casts until the goal range is achieved. However, if we haven’t seen any change in a four week period, then we’ll finish casting and start the next step.

After the child has completed the casting process, they will be fitted with day braces and night braces. They’ll continue doing their standing exercises, as well as a few ankle strengthening movements. Once their new walk becomes easy for them, they’ll slowly be weaned out of the day braces. Once the child is completely comfortable with their gait and walk, they’ll need about 10-15 minutes of standing exercises each day. They will need to continue to wear their night braces until they’re done growing to avoid losing any range of motion.

After completing the program, we ask that patients come back every three months so we can monitor their progress, make sure they are not losing any range of motion and revise the exercise program as needed. Children must complete the full casting and post-casting program to keep their alignment.

What to Exp​ect During the Casting Process

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 to have new casts applied and receive their home exercise program.

During the casting process, the child and family are treated by a physical therapist and orthotist for alignment, gait and correction of center of mass. At the end of serial casting, the child is given ankle-foot orthoses (AFOs) for daytime use and AFOs set in dorsiflexion for night use so that alignment is maintained and not lost while the child is sleeping. The AFOs brace the lower limb (e.g., lower leg, ankle and foot) and maintain the alignment that was gained during the serial casting process. 

After the casting process, the serial casting program continues with physical therapy and AFO use. Patients will have appointments every three to six months and then annually until they are finished growing.

Cylinder Casting

We offer cylinder casting for children with crouch gait deformities. Cylinder casts extend from the upper thigh to the ankle. We ask that patients in cylinder casts complete three hours of cumulative standing exercises each day to improve their strength and balance.

After their desired range of motion and alignment is achieved, they also move into braces. However, they may need to continue to wear day and night braces for years after casting.​​

Make an Appointment

Each patient and family must have a prior authorization for serial casting from their insurance company before beginning treatment.

After your child has been given a physician referral or prescription and your insurance has authorized serial casting and orthotic management, all appointments can be made by calling the Orthotics Department at 312.227.6210. Please allow two to three hours for each weekly casting appointment.

 

Resources

To learn more about serial casting, visit GaitWays.com.

Philanthropy

Your support is vital in helping us continue to make a difference in the lives of patients and families. Lurie Children’s relies on philanthropic funding to enhance its programs, services and research for children. To learn more, please e-mail the Ann & Robert H. Lurie Children’s Hospital of Chicago Foundation at foundation@luriechildrens.org or call 312.227.7500.