What is serial Casting?

The application of below the knee walking casts for the treatment of ankle/foot contractures. Each casting session after the first cast application will involve 30-45 minutes of cast removal and about 60 minutes to apply casts if both legs need to be cast. Application consists of cotton padding, foam padding, fiberglass casting material, and a walking boot.

What Restrictions will my child have during casting?

No jumping or running to prevent casts from breaking. However, your child will be free to walk and play while in the casts.

When is serial casting used?

Serial Casting is used to correct toe-walking, clubfoot, and contractures. Serial casting is recommended when a child is lacking 10 or more degrees of range of motion in their ankle. Normal Range of Motion per age: <1 year = 45 degrees, 1-8 years = 25 degrees, 9-19 years = 17 degrees

How long will my child be in the cast?

Casts are left on for a week at a time then they are removed and replaced. Serial Casting treatment is a minimum of 6 weeks.

Why Serial Casting vs Just Braces?

During serial casting your child will be cast in a comfortable position close to their end range of motion and their heel will be built up so the floor is brought up to their heel. This allows them to have a simulated heel-toe gait pattern. Each week they will be cast in a different position allowing for increased range of motion each week. When your child is put into braces/orthotics, the position is set and insurance will only cover new orthotics 1x per 6-12 months.

Case Example:

Before - 8 year 6 month old boy, dorsiflexion ROM at initial evaluation was -8 degrees right and left with knee flexed, -15 degrees on left with knee extended, and -10 degrees on right with knee extended.


After - completed 6 weeks of serial casting, dorsiflexion ROM after last cast was removed was 15 degrees right and left with knee flexed, 10 degrees right and left with knee extended.

Bartoletta, John, Elaine Tsao, and Maryse Bouchard. "A retrospective analysis of nonoperative treatment techniques for idiopathic toe walking in children: outcomes and predictors of success." PM&R 13.10 (2021): 1127-1135.

Barkocy, Marybeth, et al. "The Effectiveness of Serial Casting and Ankle Foot Orthoses in Treating Toe Walking in Children With Autism Spectrum Disorder." Pediatric Physical Therapy 33.2 (2021): 83-90.

Thielemann, F., et al. "Serial ankle casts for patients with idiopathic toe walking: effects on functional gait parameters." Journal of children's orthopaedics 13.2 (2019): 147-154.