Serial Casting

Kiddos who are chronic toe walkers or have increased muscle tone in their calf muscles lack the range of motion in their ankles to be able to walk with a normal heel-to-toe pattern. It also affects their balance and can cause muscular imbalances throughout the body due to using incorrect muscles to compensate. This then leads to difficulty performing and attaining new gross motor skills, leaving them behind compared to their peers.

In mild cases, this muscle tightness can be helped with a course of physical therapy and a home exercise program consisting of activities such as stretching, strengthening exercises, and gait training (activities to work on walking heel-to-toe). In more severe cases, however, physical therapy alone is limited. Research has proven that kiddos lacking a significant amount of range of motion benefit from something called serial casting. Serial casting can be used with kiddos who have various diagnoses, and has been proven effective in its ability to improve range of motion and quality of gait without interfering with their ability to perform daily activities. Serial casting is also a great alternative to surgery, and has improved results when followed by physical therapy and bracing.

Typically, the parent and kiddo come back into the casting room with the trained therapist. To make it less scary,  you are shown the different materials and tools used, and the kiddo can even pick out their own cast color (and sometimes more than one color). To make it more fun, kids typically choose to watch a movie or play a game while the therapist wraps their leg. It is important to know that the cast can come off if need be, however each cast lasts for 1 week. That means each week, the cast is removed, the therapist gives the muscle a little bit more of a stretch, and then new casts are made. This process continues until the full range of motion is achieved; typically, 4-6 sessions. They are given special “shoes” that strap onto the casts, and the therapist makes sure that they can safely walk with them on before leaving. Each week, the kids have fun decorating their casts and can continue with their daily lives as normal, just with 2 cool new accessories.

After the 4-6 sessions and the casts are removed for good, the therapist will assess the kiddo’s ability to walk, and may prescribe a few follow-up sessions to address their walking mechanics and/or strength. It is important to know that this muscle tightness could come back. Therefore, it is important to monitor the way your kiddo walks and does activities, and to continue with the home exercise program to ensure that all of the progress that has been made is maintained. It is also important to know that orthotics could be recommended after the course of casting; orthotics vary in size from shoe inserts to braces that go up the leg. The therapist will prescribe and fit the kiddo based on their individual needs. Overall, this process is to ensure the best results, meaning that it prevents injury and/or surgery, helps your child to walk efficiently with a normal pattern, and most importantly allows them to become a more functional and independent child.

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4.Main, M., Mercuri, E., Haliloglu, G., Baker R, Kinali M, Muntoni, F. Serial casting of the ankles in Duchenne muscular dystrophy: Can it be an alternative to surgery? Neuromuscul Disord. 2007; 17(3): 227-230.

  1. Pistilli, EE., Rice, T., Pergami, P., Mandich, MB. Non-invasive serial casting to treat idiopathic toe walking in an 18-month old child. NeuroRehabil. 2014; 34(2): 215-220.
  2. Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., et al. A systematic review of interventions for children with cerebral palsy: A state of the evidence. Dev Med Child Neurol. 2013; 55(10): 885-910.
  3. Barkocy, M., Dexter, J., Petranovich, C. Kinematic gait changes following serial casting and bracing to treat toe walking in a child with autism. Ped Phys Ther. 2017; 29(3): 270-274. doi: 10.1097/PEP.0000000000000404.


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