Have you noticed your child struggling to flex or extend a joint fully, whether it's bending an ankle or curling a wrist? Often, this limitation is due to a muscle that's become too short or tight, restricting their movement. In cases like these, doctors may turn to a specialized treatment called serial casting. This method involves applying a series of casts to the affected joint, with each cast gently nudging the joint closer toward an improved range of motion. And it's not just for kids—adults with similar issues can also benefit from serial casting.
In this blog post, we’ll explain how serial casting works, the circumstances under which it's employed, the benefits it offers, the specifics of the procedure, and much more to provide a thorough understanding of this orthopedic casting technique.
Serial Casting is a non-surgical orthopedic treatment that involves applying a series of casts to a limb or joint to improve the range of motion, reduce contractures, and correct deformities in joints affected by neuromuscular conditions.
The procedure involves a series of several casts, each worn for a period of 1-2 weeks depending on the condition. The casts are applied in a gradual manner, with each cast holding the joint in a way that stretches the muscle or tendon slightly more than the previous one. This process is repeated until the desired range of motion is achieved.
The underlying principle of serial casting lies in the biomechanical and physiological response of soft tissues to sustained stretching. By applying a cast that holds the affected limb at its maximum tolerable range, the tissues gradually adapt, leading to an increased range of motion.
Serial casting is an effective treatment for a variety of pediatric conditions that affect bone and muscle development:
Clubfoot: Clubfoot is a congenital foot deformity in which the foot is turned inward, and the heel is out of alignment. Serial casting stretches tight muscles and tendons in clubfoot to correct alignment and improve function.
Toe walking: Toe walking is a condition in which a child walks on the balls of their feet and toes, with their heel not touching the ground. Serial casting can be used to help correct toe walking by gradually stretching the tight muscles and tendons in the calf.
Peripheral neuropathy: Peripheral neuropathy is a condition that affects the nerves outside of the brain and spinal cord. It can cause a variety of symptoms, including numbness, tingling, pain, and weakness. Serial casting can help people with peripheral neuropathy to improve their function and ability to perform activities of daily living.
Hip dysplasia: Hip dysplasia is a condition in which the hip joint is not properly formed or aligned. Early intervention with serial casting can stabilize the hip in infants, promoting normal joint development and preventing future complications.
Metatarsus adductus: Metatarsus adductus is a condition in which the forefoot turns inward. It is a common condition in newborns and infants. Serial casting can be used to treat metatarsus adductus by gently correcting the alignment of the forefoot. This can help to prevent the condition from becoming more severe and can improve the child's ability to walk and run.
Torticollis: Torticollis is a condition in which the head is tilted to one side, and the chin is turned to the other side. It can be caused by a number of factors, including muscle tightness, injury, or congenital anomaly. Serial casting for torticollis can be used to gradually stretch the tight muscles in the neck and improve head alignment.
Serial casting serves as a critical intervention for conditions that impair movement and muscle control:
Cerebral palsy: Cerebral palsy is a group of disorders that affect movement and coordination. It is caused by damage to the developing brain before or shortly after birth. Serial casting stretches contracted muscles and reduces spasticity in children with Cerebral palsy.
Spina bifida: Spina bifida is a birth defect that affects the development of the spine and spinal cord, leading to weakness, paralysis, and deformities in the lower extremities. Serial casting can help to improve the range of motion and prevent further deformities in the affected limbs.
Muscular dystrophy: Muscular dystrophy is a group of genetic disorders that cause progressive muscle weakness and wasting. Although not a cure, serial casting in muscular dystrophy cases can help preserve mobility and delay the progression of atrophy
Serial casting is widely used to address joint stiffness and muscular contractures, irrespective of the underlying cause:
General contractures: A condition in which the muscles and tendons become tight and shorten, limiting the range of motion. Serial casting can help to stretch the muscles and tendons and improve the range of motion in the affected joints.
Post-Stroke spasticity: Stroke survivors often face spasticity in limbs, a condition in which the muscles become stiff and difficult to move. Serial casting can help to reduce spasticity and improve the range of motion in the affected limbs.
Degenerative conditions: Conditions that cause the muscles and bones to weaken and deteriorate over time, such as arthritis and osteoporosis. Serial casting can help to slow the progression of the condition and improve function by reducing pain and stiffness and improving the range of motion.
The serial casting procedure typically involves the following steps:
Initial assessment and planning: A healthcare provider will assess the patient's condition and set realistic goals for therapy.
Cast application: A cast is applied to the affected limb or joint in a position of stretch. The cast is made of a material that is strong and supportive but also comfortable for the patient.
Cast adjustments and re-casting: The cast is monitored and adjusted regularly to ensure that the patient is making progress. The cast is typically changed every 1-2 weeks, depending on the patient's individual needs.
Cast removal: Once the desired range of motion has been achieved, the final cast is removed. Physical therapy may be recommended to maintain and improve the gains made during the casting period.
Serial casting is generally a safe and effective treatment. However, there are some potential risks and complications, such as:
Skin irritation or breakdown: The cast can rub against the skin and cause irritation or breakdown, especially in areas where the skin is thin or delicate. This can lead to blisters, sores, and even skin ulcers.
Infection: If the skin is broken, bacteria can enter and cause an infection. This is more likely to occur if the cast is wet or dirty. To reduce the risk of infection, the patient should keep the cast clean and dry.
Pressure sores: Pressure sores can develop if the cast puts too much pressure on a small area of skin. This is more likely to occur in areas where the skin is over a bony prominence.
Nerve damage: The cast can put pressure on nerves, which can lead to nerve damage. This is more likely to occur in areas where the nerves are close to the surface of the skin.
Deep vein thrombosis (DVT): DVT is a blood clot that forms in a deep vein. This can occur if the blood is not flowing properly through the veins. DVT is more likely to occur in people who are immobile for long periods of time.
It is important to note that these are just some of the potential risks and complications of serial casting. The patient should discuss all of the risks and benefits with their healthcare provider before undergoing serial casting.
The amount of time it takes for serial casting to work varies depending on the severity of the contracture or spasticity, the patient's age and overall health, and the patient's compliance with the treatment plan. In general, most patients see significant improvement within 4-6 weeks of treatment, though it's important to note that recovery times can vary, ranging from a few weeks to a couple of years, depending on individual circumstances.
Can you walk with serial casting?
Yes, it is possible to walk with serial casting, depending on the location of the cast and the severity of the condition being treated. For example, children with clubfoot typically wear casts from their toes to their knees, but they are still able to walk and may need the assistance of a special shoe. Adults with post-stroke spasticity or degenerative conditions may wear casts on their feet or ankles, which may make walking more difficult but not impossible.
The future of serial casting is bright, with new technologies and materials emerging all the time. One of the most exciting new developments is Cast21, a waterproof, breathable, and lightweight cast alternative.
This company has pioneered an immobilization system, addressing many of the limitations found in traditional plaster and fiberglass casts. Cast21's waterproof cast alternatives permit patients to engage in water activities without concern, a stark contrast to the strict moisture avoidance necessary with conventional casts.
A significant benefit of Cast21's technology is the enhanced comfort and hygiene it offers. The open lattice structure of Cast21 casts enhances airflow, significantly improving skin health and overall comfort. This is especially critical for patients who require serial casting, as the need for multiple cast changes could otherwise increase the risk of skin complications. Moreover, these cast alternatives are much easier to apply and remove, reducing the clinical burden and patient anxiety often associated with the use of a cast saw.
The visual appeal of Cast21 products is another noteworthy aspect. With an array of colors and a unique lattice structure, these casts offer an aesthetic choice for patients, making the wearing of a cast a less stigmatizing experience, especially for children.
For patients in need of serial casting, Cast21 can offer a solution that aligns with the demands of modern lifestyles and the move toward personalized patient care. If you're interested in a more comfortable and convenient casting experience, please contact us to learn more about what Cast21 can offer and how we can assist you on your road to recovery.