What is Serial Casting?

Serial Casting is a process in which joint or joints (which normally lack full range of motion) are immobilized with a well-padded cast without forcing any tissues into stretched position.  Rather, when casting the foot and ankle, they are positioned at a comfortable position that approaches appropriate alignment, and the bottom of the cast is modified to fill any space between the heal and ground.  The casts are applied and removed in succession (usually every week) over a specific period of time.  During the process, the affected joint or joints are gradually and repeatedly set in more physiologically correct alignment resulting in an increase in the range of motion.


Why a Child Might Benefit from Serial Casting?

  • serial casting is a nonsurgical alternative used to reduce soft tissue contractures resulting in an increase in joint range of motion.
  • serial casting may reduce the likelihood of orthopedic surgery to reduce deformity
  • serial casting should provide a child with better acquisition of correct weight distribution in standing and walking

Serial Casting Process

Initial Consultation and Evaluation:

During the initial consultation, baseline measurements of the joint range of motion, strength and muscle girth as well as a gait and weight-bearing analysis of your child will be completed.  A plan of care will be created specifically for your child.

First Casting Session:

The Physical Therapist will apply the first set of casts.  Parents will receive special instructions and precautions about the casts, the pattern in which your child should practice walking and any special exercises to be done while in the casts.  Your child will be expected to walk (or stand) for one hour per day in addition to his/her customary routine.

Follow-up Casting Sessions:

The casts are removed and your child's skin is cleaned and dried.  Before reapplication of the casts, the physical therapist will remeasure and look for changes in walking pattern.  Casts are then reapplied in the improved position.  If the casts are used for standing and walking, the soles are modified to ensure stability and correct weight bearing alignment of the foot and lower leg.  The casts are usually changed every 5-7 days however, casts could be changed more frequently depending on the status of the child's skin.


How many cast changes will my child need? - Casts are changed weekly until the range of motion goal is achieved.  Casting courses typically run from 4 to 12 weeks.

What happens when my child achieves the target ankle range of motion? - Once the range of motion goal is achieved, and if it is time for new braces, it may be time for an orthotist appointment.  To maintain the corrections achieved during casting, consistent use of the day braces and night casts are essential.  It is also advised that your child strengthen the casted joints daily.

*** This is the most important aspect of the serial casting program -- if your child does not use the range he/she gains in the cast, then often they will rapidly lose it.

Are there any precautions related to casting? - There are risks associated with casting and it is important that every parent be very aware of what might occur.  Your therapist will go over in detail these risks as well as signs and symptoms to be aware of when your child is wearing the casts.

When my child is in the cast(s), will he/she be able to use the bathtub or go swimming? - Only if you agree to purchase and use a competent cast cover for each cast designed to use underwater.  Casts are not waterproof and should never to get wet.  A wet cast must be removed immediately.

How will my child's participation impact my family? - It is important to recognize that this procedure may be inconvenient and/or stressful to the parent, the caregiver or the family.  Despite everyone's best efforts, the length of the program is not predictable.  The casting may last longer than originally anticipated for a variety of reasons.  Prior to beginning the program, it is important to understand all of the demands and stresses.

How long does an appointment last? - A 1-2 hour appointment is set for your child.  The appointments are usually at the same time on the same day every week.


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