Before and After Serial Casting: What Changes for Your Child
| QUICK ANSWER
Serial casting is best known for toe walking, but our PTs also use it for other foot concerns, like flat feet and high arches. Before casting, an evaluation typically shows limited ankle range of motion, tight calf muscles, and difficulty getting the heel flat on the ground. It also shows us any secondary changes in the foot that developed as it compensated. During the weeks of treatment, each new cast gradually increases how far the ankle can bend, and by the end of a typical course, most children show meaningfully improved range of motion and a more heel-flat walking pattern. What happens afterward depends a lot on consistent use of any recommended bracing, since the gains made during casting need ongoing support to hold over time. |
Before Casting: What the Evaluation Typically Shows
Before treatment begins, your child’s PT does a full evaluation. We look at how far the ankle can bend upward, how tight the calf muscles are, and how your child walks, including whether the heel touches the ground. Toe walking is the most common reason families come to us for casting, but we also cast for other foot concerns, like flat feet and high arches.
Just as important, we look at the rest of the foot. When the ankle can’t bend the way it should, the foot often finds ways to compensate, and over time those workarounds can turn into secondary changes in the foot itself. Spotting them early helps us plan your child’s treatment. These measurements also give us a starting point, so we can track your child’s progress cast by cast and set realistic expectations for how much change casting is likely to bring for their level of tightness.
During Treatment: What Actually Happens With Each Cast
Each cast is applied with the ankle gently positioned at a comfortable range of motion available at that point, then left in place for about one to two weeks before being replaced with a new cast set slightly further into that range. Research comparing weekly and biweekly cast changes found meaningful improvement in both approaches, with weekly changes producing a mean gain of about 10.6 degrees of dorsiflexion within the first two weeks alone1. This incremental, cast-by-cast progression is how the muscle gradually lengthens over the full course of treatment.
- Before: limited ankle range of motion, tight calf muscles, heel not consistently touching the ground
- During: each cast incrementally increases range of motion over 1 to 2 week intervals
- After casting ends: meaningfully improved range of motion and gait for most children
- Ongoing: bracing and continued PT often support the gains made during casting
Immediately After Casting: What’s Different
By the end of a typical course of casting, most children show significantly improved ankle range of motion compared to where they started, along with more consistent heel contact when they walk. Many also see the secondary changes in their foot corrected. One study found that plantar heel force, essentially how much weight a child puts through the heel during walking, increased from just 5 percent before treatment to 79 percent at a six-month follow-up2. This is a substantial, measurable shift in how a child’s foot actually functions during walking, not just a subjective impression of improvement.
| PULL QUOTE
“Significant gains are made during the casting process, but it is even more crucial after casting is done, that the post casting protocol is strictly adhered to in order to ensure success.” |
What Happens in the Weeks and Months That Follow
The end of the casting phase isn’t necessarily the end of the process. Children transition into orthotics or a bracing protocol designed to maintain the range of motion gained during casting, and continued physical therapy exercises often reinforce that new movement pattern. This follow-through phase matters significantly, since research has found that toe walking can recur in some children over the following months and years, particularly when consistent bracing and exercise aren’t maintained after the casts come off.
Frequently Asked Questions
What does an evaluation typically find before casting begins?
Limited ankle range of motion, tight calf muscles, foot deformities, and a walking pattern where the heel doesn’t consistently make contact with the ground.
How does the ankle’s range of motion actually change with each cast?
Each new cast is set slightly further into the ankle’s available range than the last, gradually and incrementally lengthening the tight muscle over the full course of treatment.
How much improvement can families expect by the end of casting?
Research shows meaningful, measurable gains in ankle range of motion and heel contact during walking by the end of a typical casting course.
Does treatment end once the last cast comes off?
Not entirely. Children transition into bracing or continued physical therapy exercises to help maintain the gains made during casting.
Why does what happens after casting matter so much?
We have to treat the original cause of the toe walking, which is muscular imbalance, or the toe walking can return. Casting gets the ankle moving, and bracing and exercises afterward help the improvement last.
A Real, Measurable Change, With Ongoing Support After
Serial casting produces a genuine, visible shift in how a child’s ankle moves and how their foot functions during walking, and understanding what happens before, during, and after helps families know what to expect at every stage.
If you have questions about what serial casting might look like for your child, our physical therapy team is glad to help. Call us at 815-783-2544 or submit a contact form.
Know a family wondering what to actually expect before and after serial casting? Share this with them. It might be the answer they’ve been looking for.
Clinically verified by Abbie Zaremba, PT, DPT, Westside Children’s Therapy
Where to Go Next
- Efficacy of Serial Casting Protocols in Idiopathic Toe-Walking. PMC.
- Serial Ankle Casts for Patients with Idiopathic Toe Walking: Effects on Functional Gait Parameters. PMC.
