Serial casting for idiopathic toe walker

[Bonkerz]

Does anyone have any experience if this? DD age 7 has always toe walked. I buried my head in the San for years as my eldest has autism and I knew toe walking was a big sign if autism..... Fast forward 6 years and DD started complaining if pain in her hip and spent all her time on her toes. We have been seeing a consultant and physio for over a year but dd is now having trouble with her ham strings being to tight and tearing so a decision was made to stop physio and on Wednesday dd is going into double casts. The consultant said they will initially force her foot to neutral and it will e changed weekly for 4-6 weeks.
I suppose what I'm worried about is how much pain dd will be in. She already has ibruprofen and calpol daily. Should I get her something stronger? Does casting really see big changes?

Noone :0(

DS had serial casts for toe walking he wore them for about a month at a time with the casts changed weekly with a gradual stretch each time. He would then have a month off and then be back in for a month. In his month out of casts he also had night splints, sort of plastic L-shapes with Velcro to keep his feet at 90 degrees at night.

It did help to stretch his tendons but didn't break his toe walking habit at all. We all made a massive effort to say 'heel-toe' every time he walked anywhere and would put a hand on his shoulder to remind him.

To be honest DS was not bothered at all by the casts, I thought we would have all sorts of dramas but he could not have given less of a shit. He had them between the ages of 3 and 4 and didn't seem to have any pain associated with it.

DS is hyper mobile and our consultant thought that toe walking helped him to stabilise his hips knees and ankles. We also had some X-rays done as DD1 had developmental displaysia of the hip and some late diagnosed DDH sufferers toe walk to make up for a leg length discrepancy. To be honest DD1 was a late diagnosis and before that we had been overlooked as fussy first time parents (DS is our oldest) and as soon as we had a diagnosis for DD1 DS was X-rayed within a week and we had consultants, physiotherapists falling over us!

One thing we did was 'buddy up' with another DC who was a little ahead of us treatment wise. This meant that when my DS went to have his first set of casts put on we met up with a similar aged girl who was having her first set cut off. This helped to see what the process was like the plaster technician said some DCs freak out about the noise and vibration of the cutting tool thing. My DS giggled his head off and said it really tickled. We kept his last set of casts as a reminder to heel-toe!

He is 7 now and still mostly toe walks but will walk flat if nagged, so the casting process didn't break the habit but did increase the functional use of his ankles.

Good luck and if you want to PM me feel free. (We are now experts at the bin bag wrapped bath and how to sleep with hot feet.)

I hadn't even considered the bath issue just thought we could cope with flannels and shower over bath for hair! Have made sure she has skirts and cycling shorts for school.
She is so desperate to wear sandals and nice dolly shoes on holiday in July which is something she can't do at the moment as needs trainers for support. We have nagged that its important she puts the work in and stops trying to go on toes or she will be in casts for holiday in 6 weeks......we are hoping casts will be done by then................
She's excited but nervous I just hope it works ok for her or she will be gutted

My middle DD had this done when she was 3 and I am waiting for an appt now that she's 6 as I am sure it will have to be done again, her left leg is now very twisted looking but we were signed off physio etc last year.
Tbh the casts were no bother to her, she got around really well and didn't complain at all. Mostly she wore tracksuits and I also bought knitted type uggs that stretched over the casts that were cosy when not running around. The most difficult for her was between casts as the muscles were very sore and it took her longer to adjust to casts off then to casts on.

DS had black jogging bottoms for school with the elastic cuff bit snipped as school trousers wouldn't fit.

The main thing is to keep the casts totally dry as they are lined with cotton wool which will clump and become very soggy and uncomfortable if it gets wet. It is amazing how quickly skin can go manly in those circumstances.

You will be given some sandal type shoes to go over the casts but her toes will still be sticking out so have some BIG socks to go over them. We used some adult sized totes slipper socks as we discovered that when he got up in the night for a wee the laminate floor in our old bathroom was like an ice rink in casts.

We used to walk to school and on rainy days we would put a plastic bag over the slipper socks and then the sandal shoes over the top of the plastic bags to make sure no rain water got in them. It did look a bit odd though. He used to stay in at break time if there was standing water in the playground pretty much all the time and so made great friends with the science specialist teacher as they were both dinosaur geeks and would sit and have chat whilst the teacher had a coffee.

I'll have a think if there were any other tips I can think of.

I meant manky not manly skin

Fab tips. I appear to have completely under estimated the practical side of things.......

Today's the day for my dd...... Rang gp yesterday who prescribed buckets of ibuprofen and some ranitidine and omeprazole to counteract any effects from the ibuprofen. Am now really panicking about the practical side of things. Am trying to find a wheelchair so we can still do car boot on Sunday (regular thing we love to do but can't if dd can't walk far) and have told dh (he is taking her to get the casts) to ask about protecting cast from rain etc........... I'm dreading it! Dd on the other hand is excited and practising her heel toe walking today!

Hope it has all gone well today. Does your DD have a scooter? We found being pulled along on a scooter with both feet on it was much less babyish than the offer we had of putting him in our old pushchair.

You'll be grand

Thanks sneaky. She had it done at 2pm and came home all full of beans. They managed to get one foot to neutral but the bad leg isn't quite at 90 degrees yet. She has been hobbling about like a loon for the last few hours and is now moaning her legs are hot and her muscle is tingling! Advice from hospital was to not take her out in the rain!!

How is she getting on today? DD hasn't had serial casting but we know a lot of kids who have had it done. If she is still saying it hurts it may be worth getting it helped out sometimes the inner bit can wrinkle and cause pressure sores which mean the cast needs re done.
My DD still strikes the ground with the front of her foot. You can get squeaky shoes that make a sound when they heal strike to encourage them to heel-toe can't find them big enough for my DD so I got some dog toy squeaker and put them in her trainers to practise with. A fun thing to do rather than nag nag nag. Balance bike (take the peddals of a normal bike if you can't get one bigger enough) are good at encouraging a good walking pattern. Lots of bare foot walking on unstable surfaces is good too.

A good first night. She's getting used to them. Complained of sore ankles this morning but the meds had worn off an I reckon it just cos this is the longest they have been in this position. I have noticed she has stopped straightening her knee when walking which isn't good as that's when the stretching will occur. Will have to watch her today me thinks.

DS1 (5) is an idiopathic toe walker with a leg length discrepancy- in the shorter leg the foot is a lot more stiff. He has had three lots of 4 week castings in the past year and the specialist is recommending another lot but it feels like its so very frequent :( I especially feel sorry for DS1 that it is nearly summer (if it ever gets here) meaning water fun in the garden etc is going to be difficult to be involved with. We are basically delaying the need for surgery while he is so young and has a lot of growing to do. Some great tips above about socks and the funny sandals they give you. I tend to just drive to school when it's raining. I was given the Limbo Cast Protectors by a lovely MNer whose child didn't need them anymore- I would thoroughly recommend them, means that they can have a bath still. Glad your DD found it ok, good advice about getting cast looked at, as the folds in the cast can rub as was said previously. Once she comes out of the cast try and keep up with stretches - hope you are seeing a Physio too? There's always an effect with the casting but DS just forgets and springs up on his tiptoes again soon after. :(

Thanks for posting. Dd has a leg length difference of 1.3cm which is why it's taken a year to get help for the tight Achilles as they didn't want to treat one and then the other. Because of the length difference she does have one worse leg as has torn ham string. No physio given for ages as they were worried that until she had more stretch on her Achilles they were causing more damage to ham string its definitely going to be a learning curve for dd and me.

Dd had her casts changed for the first time today. She has coped really well this last week especially with school too. Casts off today and new ones put on. Nurse said her foot went to neutral a lot easier than last week but that's as far as it would go so they have set her casts to neutral again and want to leave her for two weeks! I'm not sure how normal this is?

What do you mean by 'neutral'? DS1 is being cast for the 4th time tomorrow :( I hope he can cope ok in the heat. The casts can get so smelly!

By neutral I mean that her foot is at 90 degrees so flat they can't push it up at all because her Achilles is so tight. She actually came out of school in years today. She said her legs have been buzzing and she has pain behind her knees so I can only assume they must have got a small amout of bend on her foot for her to be in pain.

90 degrees is the aim for us! Would settle for that. Plantegrade is what the hospital refer to as 90 degrees. I think we just have to really really be hot on exercises, in the end it comes down to how we are with him and support him to exercise his feet. See how your daughter is tomorrow but if the pain continues I would take her back into the plaster room, they can sometimes have ripples in the plaster that rub.