Serial casting is used to help improve a child’s walking pattern. Serial casting is usually carried out over a 6-week period (this is subject to change). It involves soft casts being applied to one or both legs. The cast will be applied weekly/biweekly and remain on for one to two weeks at a time. 

Parent and guardian information

Serial casting appointments will take place on a Friday morning in the plaster suite situated in Gate A of the hospital.

• As casts will run from just below the knee to the toes, your child will need to wear loose clothing on their bottom half, ideally shorts/dress/skirt/stretchy trousers.
• Casts are to be removed the night before your next casting appointment, which can be done by hand.
• Please wash feet thoroughly and moisturise the night before your next casting appointment as well as check for any red/sore areas. If there are any red/sore areas please let the plaster technicians know at your appointment.
• Your child will be given plaster shoes at their first casting appointment that they will wear whilst in serial casts. Please bring them with you to each appointment as only one set of shoes will be issued for the duration of serial casting.
• Your child will be able to walk in the casts. However, activities that include running/jumping and swimming will have to be postponed until your child is out of casts. This is to protect your child’s skin and prevent infections.

Serial cast care

Check your child’s toes daily/regularly to make sure that there are no issues for concerns.

• Toes should be pink and warm to touch with no signs of swelling.
• Toes shouldn’t be blue or red, swollen or very hot or cold to touch.
• Ask your child daily if the cast is comfortable, and they are not experiencing any numbness, burning or tingling sensations.

If you notice any of these things or are unsure, please contact the physiotherapy or plaster team for help.

Please always keep the cast dry as a wet cast can lead to skin infections. For showering or bathing whilst in casts you can purchase a waterproof cover that can be applied to the casts - Limbo Cast care covers – order line: 01243573417 / www.limboproducts.co.uk

If you do not have a cover, we advise that your child has a strip wash at the sink.

After casting / physio exercises

After casting it is important that your child starts the following exercises to maintain their new foot position.

• Standing on a step, let the heels drop down over the edge of the step so you feel a stretch down the back of your legs. Hold for 30 seconds and repeat 3 times.
• Sitting with feet against wall, pull your toes up towards you so you feel a stretch down the back of your legs. Hold for 30 seconds and repeat 3 times.
• Standing with hands on a chair or wall, put one leg in front of the other. Lean forwards so that you feel a stretch down the back of your leg. Hold for 30 seconds, then swap legs. Repeat 3 times on each leg
• Walking heel-toe like you are on a tight rope for 10 steps. It is important that you put your heel down first. 10 steps x 3

Once serial casts are removed your child should aim to carry out these exercises 3 times a day minimum. It is important that the exercises are regularly practised to maintain and maximise their foot range of movement. They will be booked into a follow-up physiotherapy appointment to monitor their progress.

Your child may be referred to orthotics after casting for a splint. This will be determined on the degree of change needed at the foot. 

Information for school and sports clubs

During serial casting, the child should be excluded from:

• Sports and PE
• Swimming as they cannot get the casts wet

Please be mindful during any wet activities or playing outside in the rain. The casts will be damaged if they get wet and need to always remain dry.

Normal school shoes will not be managed whilst in cast. Your child will need to attend school in sandals / plaster cast shoes or trainers which fit over the cast.

School trousers will not be managed whilst in the cast. Your child will need to attend school in shorts or loose trousers to ensure that they can fit the clothing over their casts.

Going up and down stairs is fine in these casts but please ensure that risk assessments are carried out for school and sport club environments.

Playing outdoors in the playground is fine and encouraged. However, running should not be prolonged, a few running steps to participate in lunch time play only. A risk assessment for your environmental needs.

Useful contact numbers

• Physiotherapy Department - 0121 728 9442
• Plaster Technicians - 0121 685 4279