Serial Casting

Serial Casting? What is that?!

The way we walk is so important! There is a fancy term for this, it’s called biomechanics. 

If you think about how we walk, we should always contact our heels first. This then sets off the big chain of events that makes up our biomechanics, including our knee bending, our weight moving forward, and then our toes pushing off the ground to prepare for our next step. 

Some kids who walk on their toes, or have increased muscle tone in their calf muscles, e.g. someone with a diagnosis of cerebral palsy, will not be able to walk in a typical heel-to-toe pattern. This can cause muscular imbalances throughout the body which can then lead to lots of compensations, including:

  • Poor balance
  • Difficulty running
  • Frequent falling 
  • Difficulty learning new gross motor skills
  • Struggling to keep up with their peers

Serial casting is a tool used by paediatric physiotherapists, to change these kids’ biomechanics and help them to walk with that heel-to-toe pattern!

Serial casting will not only help to improve your child’s walking pattern (as we discussed above), but it can also help with:

  • Ensuring their current orthotics fit comfortably without rubbing
  • Ensure they don’t get pain in their legs 
  • Reduces the risk of potential surgery or deformity as they grow
  • Improve the effectiveness of botox treatment 

So what will it look like?

Serial casting involves a series of casts (anywhere from 3-5 casts), being put on continuously for a week at a time in a comfortable, but stretched position to try and improve the length of your childs muscle. 

There is no set time as to how many weeks your child will require casting but your physiotherapist will be able to indicate an approximate time period at the beginning of your child’s cast series. Most cast series are completed within three weeks but if the muscle is very stiff or tight, it may take longer. 

Each cast remains in place for approximately one week and is then changed and re-applied. At each follow-up appointment throughout the treatment, the cast will be removed using a special tool called a cast saw. Then, the therapist will clean your child’s leg or arm and measure how much motion has been gained. A new cast will be applied with an increased amount of stretch.

While the cast is on, your child can participate in most of their normal activities. Walking and standing are highly encouraged, as this will increase the stretch! In the case of leg casts, your child will be provided with a special shoe to limit slipping and ensure ideal posture. Although it is important to remember that the cast cannot get wet, and you should never stick anything down the cast… so avoid the sandpit!

It is important that children participate in physiotherapy and a program of home exercises in conjunction with the serial casts to maximise effectiveness.  

Will it be uncomfortable for my child?

This is a very common question from parents, particularly if it is your child’s first experience with casting. Once the cast is in place, your child shouldn’t find it painful but may feel some mild discomfort or cramping due to stretching. This occurs most frequently during the first two days and can often be settled with children’s paracetamol or ibuprofen. If you are concerned about the discomfort, contact your physiotherapist immediately.

What happens after casting is finished?

This is different for all children, and your physio will discuss this with you as the end approaches. For some children, a splint may be made during the casting period, to be worn after the last cast is removed to maintain the muscle stretch you gained with the casting. This will depend on your child’s specific needs. 

Serial casting may seem scary, but it is an approach that your physiotherapist is highly skilled and trained in. It is also part of the BIG picture, and is used in conjunction with other therapies to get the best outcomes for your child. 

If you think your child might benefit from serial casting, or you would just like a review with a physiotherapist, come in and see Eden at Canobolas Kids Physio!