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Serial Casting: A Milestone Therapy Parent’s Perspective!

To give you another angle to consider, we decided to get one of our mom’s experiences with serial casting for her toddler.

Sophia: 

What did you know about serial casting when it was brought up as a treatment option for your child? 

Mom: 

I knew that it was one of the possible steps to take for our child. If I remember correctly, the choices were either braces or casting. And if casting didn’t work, then botox was the next step. If botox didn’t work, then they would cut the Achilles tendon. That’s how they (the child’s orthopedic doctor) described the steps to us. That was all I knew. Serial casting sounded like what it’s named, and that it would simply be casts on our kiddo’s feet, put on in succession. I had to look online to see what a serial cast would look like, and because I really had no idea about the process. 

Sophia: 

Yes, I think for any parent, when they hear about serial casts as an option it can be a little scary, almost daunting to hear.

Mom: 

Yeah it is. And I honestly didn’t know if it was going to be casts from her foot all the way up to her hip, including the knee, not including the knee, if she was going to need a wheelchair to be pushed around with the casts, or a special walker. And when she did get her casts on, that’s when we got the walker because she was a little clumsy with the casts on. We had to check with the orthopedic doctor because we weren’t sure if it was ok for her to be falling that much. We didn’t have a ton of guidance from them, and we wish we would have known more about the size of the walker before we got it, however, it turns out it will be good for her for the long run now that she’s growing.

child with walker and serial casts on both feet

Sophia: 

Yeah I know the walker was a quick choice by you guys, and it turned out to be really helpful for your child. She’s really taking to it and uses it more often than she did before, and she likes to use it. 

Mom: 

Oh yes, it was an easy transition to make since she was falling so much. The walker was a natural transition for her since it offered more stability.

Sophia:  

Did you have any questions about the process, and were they answered?

Mom

Oh yes, the physical therapist that performed our kiddo’s serial casting did an amazing job. She had a chance to explain to us what was going on, and she helped us get a very quick appointment because we had waited a long time for the insurance process. She walked us through what we should expect, and how to take care of the casts. Honestly, my husband and I were on edge when our child first got her casts on because she drops everything, food, liquids, toys, you name it! We knew we had to keep the casts dry, otherwise we would have to take them off, so we were really aware of that aspect of it when she had her casts on. We also decided to push her potty training off a little bit until we were done with the braces because you have to keep those dry. So, if you are a parent thinking about treating your child with serial casts, that’s something to think about. But yeah, the physical therapist that performed her serial casting put all of our fears to rest. The first two days, our kiddo didn’t really like it, but after that she started rolling with the punches.

2 serial casted feet of child

Sophia

The thing that I saw, when your child first got her casts on, was that she was very unstable. But, as soon as you introduced the walker, that helped immediately. I feel like she started learning that she had to put her leg a little further out in front of herself when walking with the walker so she could take full steps and stay balanced because of the casts, and the walker allowed her to do that. And that helped her mechanics with walking in general, so when the casts came off, that was a benefit. 

Mom: 

Yes, and in addition to her serial casts, the clinic gave her flat boots to put on over the serial casts to add that stability, because the casts aren’t totally flat on the bottom. The bottom of them are curved along the outside since they are wrapped around your child’s feet. And most of the time, they give your kid boots to wear with the casts.

Sophia: 

What are some pros and cons that you think other parents would want to know about serial casting? 

Mom

One of the pros is that it definitely got her to a place where her feet were flat. The casts stretched her muscles enough where she couldn’t walk on her toes anymore. We saw that walking on the balls or toes of her feet was exhausting, especially for her leg muscles, and it’s also very unstable. So the casts also got our child to a place of stability.

The first con I can think of is, the appointments are an every week obligation. For some parents, depending upon their schedule, this might be tricky. You will have to find time in your work schedule or your day for the appointments. They are about an hour each, including travel time and the 30 minutes of the actual appointment. Also think about daycare pick ups/drop offs. This obviously doesn’t relate to everyone, but it was a con in our column because my husband and I both work full time.

Another con is trying to find a wardrobe that would work with braces. It’s a good thing leggings are a thing right now because they have a lot of stretch factor. If you are able to do this in the summer, that might work better because those are very easy to get on/off over the casts and boots. If you’re looking for things that are winter appropriate, you might have to cut them or find flared jeans to fit over the casts. We really did have to go shopping, we had to ask people for shorts or dresses to get her through that period of time. I think that was the most shopping we have done for her in her life for that period of time. 

Sophia

I think you said that your mom brought over soccer socks that go over shin guards for your kiddo to wear. 

Mom: 

Yes, she did! Honestly, knee pads probably would be a good thing to buy for your child if they go through serial casting because she was falling on her knees a lot with the casts on. And that leads into another con, the weight of the casts, and the way they made her walk, contributed to a lot of instability. So she fell pretty frequently with the casts on.

Another pro is that she is in a place where she has so much independence and mobility back since she falls less from her toe walking. And for some children, that’s a complete fix for the problem. For other kids it’s not, but it at least gets you back to a point where you’re stable. So for our child, it wasn’t a complete fix, but she got her stability back so she can become more mobile and maintain her independence now. 

young girl with 2 serial casts and walking boots

Another pro is that after the casts, we had to get our child AFO’s ( ankle foot orthosis). What we saw was that because the casts were pretty heavy, the AFO’s in comparison were much lighter for her. So, instead of going through the adjustment of walking with that extra weight on her feet, she actually experienced lighter material that made walking with AFO’s easier for her. That made her transition to the AFO’s much easier, as well as the routine of having something on her feet. She really was more willing to wear the AFO’s, and we think that’s due to the casts. So if you’re going to have orthotics after the casts, they definitely help. 

Sophia

And that was something that we talked about before this process. It was difficult for her to get her ankles to neutral, so wearing AFO’s that were going to prevent her toe walking was going to be very hard because her muscles were so tight. And that was the goal, to stop the toe walking. That was a benefit that we saw, as well as, the routine of having the casts on continued with the routine of having the AFO’s on. 

Mom

Absolutely. It’s so hard to remember more pros since this was a little while ago, but can you remember any more?

Sophia

As a physical therapist, I saw her independence grow because she could get around more easily. And for you and your husband, you didn’t have to hover around her all the time in fear that she was going to fall. There’s still a little bit of instability with your child, so you still have to be close to her. But I think the braces gave her much more independence in any environment. Do you remember when we would be in the kitchen during a session? She desperately wanted to sweep the floor and she couldn’t because she couldn’t keep her balance.

Mom

And now she’s in the kitchen loading dishes! And as I’m thinking, when we go to the playground, obviously we are still around her, but we no longer have to hold her hand the whole time that she wants to be on the playground. That was a huge difference!

Sophia

I think that’s a really wonderful thing to know that your little girl is growing and she was having a little bit of trouble doing the things she wanted to do, and now she can do them. 

Sophia

What was your experience like when your child had serial casts on for treatment?

Mom

I’m just remembering, buy all the socks! I remember there were so many holes in the socks that were over her casts, that we ended up changing the socks twice a day, once before bedtime, and once after breakfast. (We recommend these soccer socks, these grip socks, and these wide socks). The biggest schedule change for us was that we could only give her a bath once a week, because you had to keep the casts dry for the week until you took them off. This led us to figuring out unconventional ways to clean! Since she fell a lot, she was constantly dirty, and we actually figured out that a flea comb is really good at getting dirt out of hair. We would focus on keeping her hair clean, and keep her skin clean with damp cloths, especially after coming home from daycare. 

Sophia: 

How was your child’s first day with the casts on?

Mom

She hated them. She kept saying, “Take them off Mommy, take them off”. And of course I told her that we couldn’t. She definitely had a tantrum or two on the first day, but after that she was fine. She was also really tired, because the casts are heavy. After her first casting, we scheduled three days off of daycare so she could rest and so we would know what to tell the daycare depending on how she adjusted to the casts, so they could be prepared as well. We also kept her home the whole day when she got her new casts for the week, so we could see what we would need to relate to the daycare in case anything was different. 

Sophia

Do you remember her first appointment? We were trying to get her to walk with the casts on and she kept saying that her “shoe” hurt?

Mom

Oh yeah I remember that. She was very nervous about the way her shoe felt, and she said it was painful.

Sophia

Yeah, we had to explain to her, “does it actually hurt, or is it different?”, because she’s so young. I think she was feeling the stretching sensation and she didn’t like it. It’s not comfortable.

Mom

I’m sure it didn’t feel great. And when she said it hurt, I did believe her and I was a little worried. Unfortunately, that was a part of it though because we had to stretch her muscles through the casts to get her where she is now. And the future appointments went smoothly, it was like she didn’t even notice it. I also would treat her after every appointment so she learned that it was a positive experience and so she wouldn’t be nervous. 

Sophia

Yeah that’s really important to do. I think she did really well for her first appointment, definitely bringing the distracting toys helped. 

Mom

Oh yes, the fidget toys you suggested helped immensely. They basically lasted the entire appointment and then we would follow up with a Youtube video if we needed more time. Also, bringing the stickers was good for her because you know she likes stickers. 

Sophia

Thank you so much for your time.  I know a lot of our families will appreciate your insights!  It’s appreciated!

If you think your child walks on their toes, has trouble maintaining flat feet when standing or walking, appears to have stiffness in their legs, or frequently trips because they’re up on their toes, a physical therapy or occupational therapy evaluation is recommended. It’s never too late or too early to have your little one assessed. Learn more about the serial casting process in our recent blog. Contact us to schedule an appointment today! 

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