Serial casting is a common procedure used by physiotherapists and podiatrists to stretch the calf muscles of the leg.

Children may have shortened calf muscles because of spasticity, limited movement or long-term muscle tightness.

Some of the things you may notice if your child has tight calf muscles include:

• frequent falls or difficulty walking due to poor balance, lack of heel contact, or toes dragging or catching on the floor
• pain or discomfort in the foot or ankle
• difficulty walking or running
• increased difficulty with physical skills such as jumping, hopping or kicking a ball
• getting tired quickly when walking
• difficulty putting on an orthosis (splint), or pain when wearing an orthosis, sometimes due to the splint rubbing against the leg or foot.

It is important for you and your therapist to have clear goals in mind before starting serial casting.

It is also important to plan ahead. For example, serial casting can be uncomfortable during hotter weather. Your child may also have events planned that could be more difficult whilst wearing a cast, such as a swimming carnival or school camp.

Serial casting – what happens?

Serial casting refers to the process of placing one or both ankles into a cast over a period of four to eight weeks.

The amount of time spent in casts varies depending on the amount of muscle tightness and stiffness present.

Before the serial cast is applied, the physiotherapist will measure your child's range of movement in each calf. They will also assess your child's walking and other physical skills.

When the cast is applied, the physiotherapist will tell you when it should be removed.

If Softcast™ is used, the cast may be removed at home. This allows a short break between casts and gives your child the opportunity to have a bath.

Benefits of serial casting

After serial casting, your child should be able to move their ankle, either independently or with assistance, through a greater range of movement than before.

This may result in:

• fewer falls
• reduced or absent toe dragging
• improved physical skills
• less discomfort or pain in the leg or foot
• improved ability to place their heels down or feet flat when walking
• increased ease when putting on splints and improved comfort when wearing them
• increased confidence when walking or running.

There is no set time for how many weeks your child will require casting, although your physiotherapist should be able to give you a rough idea before treatment begins.

The length of treatment will depend on how quickly your child's calf muscles respond to the stretch provided by the cast.

How is serial casting done?

Movement ranges are measured by the physiotherapist.

Your child will lie on their back or front. The physiotherapist or podiatrist may ask you to assist by holding your child's knee.

The physiotherapist then holds your child's ankle in the desired position and places a stocking on the leg up to the knee.

A white cotton wool wrap is placed around the whole leg from the toes to just below the knee.

Softcast™ is wrapped from the toes to below the knee. This is the first firm layer applied to the leg.

The toes remain exposed.

A rigid backslab is then measured and applied.

Your child can choose the outside colour of their cast.

Things to check when the cast is on