Serial Casting: Treatment for Idiopathic Toe Walking

You are concerned your child still walks on her toes, and you have taken her to an orthopedic specialist who has given her a diagnosis of idiopathic toe walking. Since idiopathic toe walking can lead to more serious leg and foot problems if left untreated, an aggressive treatment is sometimes necessary. I remember the shock I felt when my son's specialist announced he would need to go through six weeks of serial casting.

Serial Casting for Idiopathic Toe Walking: Why casts?

Serial casting is usually the first step in treatment for idiopathic toe walking for a few reasons. First, the casts are on your child's feet constantly, so it is a reliable form of treatment. The casts are on and they are going to stay on, whereas braces can be removed, thus disrupting the course of treatment.

Serial Casting for Idiopathic Toe Walking: What do the casts do?

In the case of idiopathic toe walking, the tendons at the back of the legs are too short, so the heel of the foot cannot reach the ground for normal heel-toe walking. The fiberglass casts are set on the foot to stretch out the tendons gradually, lengthening them to allow for a normal gait once the casts are removed.

Serial Casting for Idiopathic Toe Walking: Why do the casts need to be changed so often?

My son's orthopedic specialist ordered the serial casts be changed every two weeks. In idiopathic toe walking, the tendons need to be stretched gradually or your child will be in tremendous pain and it could cause damage to the tendons if they are stretched too quickly. Each time the serial cast is changed, the angle of the ankle is changed to further stretch those tendons.

Serial Casting for Idiopathic Toe Walking: Can my child walk in the casts?

Yes! Walking is actually encouraged during the serial casting treatment, because it will help stretch the tendons. Your child will be given walking boots to slip on over the casts.

Serial Casting for Idiopathic Toe Walking: Do the casts hurt the child?

Because the casts are stretching the too-short tendons, there will be pain at first. Your child walked on his toes for a reason - it wasn't comfortable to put his heel to the ground. Now that heel is being forced to the ground, causing your child to walk rather flat-footed. Also, your child will be using different muscles to walk, which will cause the muscles to ache.

However, from experience I know the pain only lasts the first day or two after a serial cast change. An over-the-counter pain medication such as Tylenol can be used to manage the pain until it subsides.

Serial Casting for Idiopathic Toe Walking: Won't his ankles be weak after the casts are off?

This is the one thing I wish my son's doctors had been more clear about. After spending six weeks in casts, the ankle muscles become very weak and will sometimes even atrophy. This is completely normal, and it may take some physical therapy to get the ankles strong again.

The first time my son was out of his casts for a cast change, he couldn't walk and said it felt like his ankles were breaking. However, after his casts were off, he was walking pain-free by the end of the day.

Serial Casting for Idiopathic Toe Walking: Do the casts really work?

I am very happy to report that in the case of my son, the serial casts did work. He got his last casts off the other day and has been walking in a normal heel-toe gait. His orthopedic specialist did prescribe braces as a follow-up, to ensure my son doesn't return to his habit of toe walking.

However, like all medical treatments, there is no guarantee serial casting will correct idiopathic toe walking. Your orthopedic specialist will explain the various procedures and risks associated with each course of treatment of idiopathic toe walking.