Serial casting clinic

serial casting girl sitting on the red ball

This clinic is for children and young adults who have pain in the lower limbs or functional problems because they toe walk.

For children who are toe walking, these casts help to re-educate the walking pattern and to stretch the soft tissue.

You can find more information about idiopathic toe walking here.

Your Physiotherapist will discuss treatment with you before any casting is started.

For more information about serial casting, please refer to the Trust leaflets, Serial casting and Serial casting: care advice for parents and schools.

Why do we serial cast?

The main reason to use serial casting is to stretch tight muscles that don’t seem to be stretched enough with exercises alone. Serial casts are used to give a long stretch to muscles and tendons that have become tight or shortened.

The aim is to hold the ankle and foot in the right position for a prolonged time using plaster of casting bandage. This is done by applying a series of casts, usually once a week, while attempting to gradually improve your child’s range of ankle movement.

Casts will be changed on a weekly basis until the patient's range of movement progresses to their most functional level. Each patient responds differently to casting; therefore the number of casts will be determined by the therapist. Generally, casting can last anywhere from three to six weeks.

This treatment will be carried out in the physiotherapy room. The appointment is around 40-60 min long.

How long will my child be in cast?

The amount of time spent in a cast and the frequency of cast changes will be decided by your child's physiotherapist taking into account:

  • Your child's tolerance of the casts
  • The amount of increased movement needed
  • The ease with which shortening responds to treatment.

What to bring and what happens on the day

  • When attending for your serial casting appointment, please bring with you any toys, books or electronic devices for your child to use as a distraction during the appointment.
  • Your child should wear or bring loose fitting trousers or shorts to allow for application of the casts. Prior to the appointment, please encourage your child to bath/wash the skin as this may not be possible for one/two weeks after the cast is applied.
  • On the day of the appointment, a member of staff will explain the procedure and you can ask any questions.
  • Protective soft socks and pads will be applied to the child’s leg(s) and then, while attempting the stretch, the soft cast will be applied from just below the knee to before the toes. Your child should be able to choose a coloured bandage for the cast and may be given special shoes to wear.
  • We use special casting materials that can be quickly and easily removed without a cast saw.  Parents usually remove the casts at home on the day before new casts are applied.

Who is on the Team?

The physiotherapy team with years of experience in working with children and with specialized training in management of contractures and casting techniques.

The child: 
Those whose functional and movement skills are limited due to limited joint motion caused by tight/stiff muscles.

The family/caregivers: Expected to help the child with a home exercise program during and after serial casting. The exercises help the child to get and maintain as much use as possible from the joint motion gained from the casting. The biggest challenge is keeping the cast dry, especially during the bathing process.

School: to help to continue with exercises and monitor feet while in the cast.  The patient is able to participate in school and other normal activities while the cast is on.

What happens after the casting is finished?

The post-casting programme is just as important as the serial casting.  Therapists will make recommendations for home exercise programme to help your child continue to improve. Therapy is often needed to help gain strength in the new range of motion.

The physiotherapist jointly with family will determine what the patient's needs are after casting. Sometimes a child will require orthotics / splints after the cast procedure is complete to help maintain the patient's range of motion.

The process of referral:

  • GP / Paediatrician can refer your children to the paediatric MSK physiotherapy service for the initial physiotherapy assessment.
  • The physiotherapist evaluates the child to identify limitations and determine goals and best approach/interventions on the first visit.
serial casting being done on child's foot