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What is Serial Casting?
Serial Casting, meaning “multiple casts”, is a minimally invasive treatment which aims to lengthen a shortened or spastic muscle with the use of temporary casts.
Serial casting is the process of applying and removing an individual or series of lightweight, fibreglass casts to a leg (or less commonly, an arm). The cast exterior is firm with soft padding interiorly (inside). This combination of materials protects the skin while supporting the boney structures of the foot and ankle. The stretch from serial casting is very slow and gradual, so serial casting should not be painful. If your child has pain while the cast is on, please inform your orthotist. For the purpose of this patient resource we will focus on serial casting of the leg.
Prior to the application of a serial cast the ankle muscles are stretched and ankle range(s) of motion is recorded. The ankle is then casted in a moderately stretched position. Casts are kept on an average of 2 weeks. Depending on the outcome of the initial serial cast and patient goals additional casts may be applied with increased stretch.
Your orthotist and therapist, with your input, can help you decide how many casts your child will need and how often to change the casts.
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How Could Serial Casting Benefit my Child?
Serial casting is a non-invasive procedure to help relieve contractures of the muscles, ligaments and/or tendons.
By increasing the range of motion at a joint (often the ankle) force generation by the previously shortened muscle may be improved. Serial casting may also combat the progression of a deformity.
As a result your child may more effectively use his or her arm or leg, better tolerate passive or manual stretching, or be able to fit and wear a brace or splint more comfortably.
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If your child is receiving botox it is important to plan ahead and book your initial appointment prior to or shortly following your botox appointment. Serial casting is commonly scheduled 7-12 days following botox.
At the initial appointment range(s) of motion at the ankle are recorded by your orthotist. At this appointment the initial serial cast(s) is applied. Distractions such as favourite toys, snacks, music or tablets are welcome to help keep your child relaxed during this appointment.
Cast boots will be provided to allow your child to remain active while wearing their casts. Children should be encourage to continue weight bearing activities such as standing and walking while in casts to improve serial casting outcomes. Your child should wear their casting boots both indoors and outdoors to prevent slips. There is no charge to this rental service assuming boots are returned in good condition.
Long legged sitting and/or the use of knee-immobilizers may be suggested by your physiotherapist or orthotists to further improve the stretch to the gastroc muscle.
Packing List: favourite distractions, clothes that can fit over the serial cast (shorts, tear away's or loose/baggy pants)
Follow Up Appointments
Most serial casting appointments are spaced 2 weeks apart for optimal outcomes. During follow up appointments ranges of motion are re-evaluated to monitor the progress and casts are either a) removed and then reapplied b) removed and not reapplied.
There may be anywhere from 1-3 follow up appointments depending on the outcomes of each serial cast and the feedback from the patient and family.
Removal of casts are performed with a vibrating casting saw. While there is no pain or discomfort experienced during this process the saw is loud and can be scary for young children. Hearing protection will be provided to you and your child. All enjoyable distractions are welcomed at this time.
Following the completion of serial casting it is encouraged that children return to wearing their orthoses on a regular basis. Your orthotist will make required adjustments to previous orthoses or cast for a new orthoses to account for significant changes in the range of motion. Please bring your child’s orthoses to this appointment.
Home stretching, night splints or knee immobilizers, and maintenance of ongoing physical therapy treatment are also suggested following removal.
Packing List: favourite distractions, current orthoses
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Will my child walk better with the serial casts?
Some changes in walking pattern are expected, and it may take a couple of days for your child to get used to walking with his/her new serial cast. Any concerns regarding your child's walking while in the serial cast should be discussed with your orthotist.
How can I bathe my child?
Serial casts must be kept out of direct water. Bathing can be accomplished by sealing the cast with a bag or purchased cast cover. A sponge bath may also be a preferable alternative.
What do I do if my child is complaining the cast is itchy?
It is not uncommon to experience occasional this while wearing a cast. This feeling can be alleviated by direct cool air into the cast from a hair dryer. Do not allow your child to stick any objects down inside the cast to scratch. This could cause injury or infection.
How do I keep my child’s foot dry/warm in the fall/winter?
To keep your child's foot warm and dry consider putting a bag on over an oversized sock.
Should my child stay at home while he/she has a serial cast?
Your child should be able to continue most regular day-to-day activities. It is encouraged that your child remains active while in their serial cast to gain the greatest benefit from the serial casting.
What should I check on while my child is wearing a serial cast?
Listen for any unusual comments which suggest increased pain with wear and check for normal toe colouration. If any concerns should arise contact your Orthotists as soon as possible.
What should I do if I need my child's cast removed and my orthotist is not available?
If this does happen the cast can be removed at your nearest hospital emergency room. Bring your emergency release form with you. This form will be provided to you at your child's initial appointment.