Serial casting anyone?

[sapphirestar]

Dd has toe-walked since day dot, we all thought it was a bad habit she would grow out of but she didn't (just turned 5) so I took her to the GP. GP referred us to a podiatrist and she referred us to physio.

Saw physio today and he's recommending serial casting as her foot isn't as flexible as it should be and he doesn't think the stretches he's asked me to do with her will be enough. Lots of terms I didn't understand flying about but I gathered she's at 'neutral' now and her legs are the same length which is good.

I am in total shock as I wasn't expecting this to be suggested on day one, thought it would be further down the line if stretches/other treatments didn't work. Horrible feelings of guilt that I didn't take her sooner, podiatrist didn't think there was a problem yet but that we needed to break the habit before it caused damage. Seems now that the damage has already been done.

Anyone any experience of this? What practicalities do I need to consider? He's already told me the casts must be kept dry. Feeling a bit wobbly tonight :-(

No-one? Please??

I haven't heard of it in a child of 5 but have some experience in a younger age group. Strip washes are the way forward. There are some plasters that can be be immersed in water (for the life of me can't remember what it's called). Also have you seen anyone else? Orthopaedic surgeon? You can ask for a second opinion too.

Questions to ask the Physio-why does he think she has tight muscles? Does he think it's simple idiopathic toe walking? Has she seen a paediatrician to rule out any neuromuscular causes for the toe walking?

The serial casting aims to gradually stretch the Achilles' tendon with a low load long duration stretch. Will mean a weekly cast with progressively increasing stretch on the Achilles' tendon. If both feet (bilateral) then walking will be difficult obviously. Casts would be left on for max of 7 days and changed. Depends on how bad the tightness is but could involve 4-6 changes of plaster.

Hope this helps-haven't done any serial casting for a bit (and I did arms) but principles won't have changed. Let me know if you want any more q's answered.

Thanks for the replies.
Yes it's idiopathic toe walking, podiatrist called it habitual toe walking but I gather they are the same thing? Not seen a paediatrician, think that would be the next step if the casting doesn't work. The tightness has been caused by the toe walking, he had his colleague in to confirm what he was thinking and she was in agreement.

They are suggesting weekly casts, for three weeks initially and did say depending on how she responds it could go for up to 6 weeks.

JoulesM Will it hurt her? I broke my leg as a teen and can remember the discomfort of not being able to bend my leg. It is both feet. She won't be able to wear tights as normal so need to find some suitable trousers for school, and socks to fit over them as it's too cold to have bare toes!
I gather it'll be slippy on tiles/laminate flooring so these slipper socks with rubber grips might be the way forward?

More - Why not in a child of 5? Dr Google said if a child hasn't out grown the habit by 3 then it's time to see a doctor. Feel guilty that I waited too long/angry that nursery etc didn't pick up on it. Mostly guilty though

Hey, don't feel guilty. My ds1 has had casting 4 times since he was 4, for idiopathic toe walking. He's nearly 6 now. It's definitely not too late for your daughter. His legs are 8mm different in length. He sees a paediatrician between castings who monitors his progress. He did have physio but all thy could really do was to suggest stretches. Some stretches from the castings are better than others. It doesn't hurt, they just feel like its stretching their muscles. The only uncomfortable thing he's had is if the cast is rubbing. You make it into something fun for them, choose the colour of the cast wrap, get it signed by her class, take pictures so she can share with the class. A good thing to get in advance is plastic limbo cast covers so she can have a bath with her cast on (google it and order online). Do feel free to pm me with other questions, I have been helped by talking to other MNers before ds's casting.

Limbo waterproof cast protectors might be worth getting - can be used in the shower and I once saw a child use one in a pool so they must be pretty waterproof. DH used one when he was in plaster for a while due to a ruptured achilles tendon.

I worked with a little boy a few years ago who regularly had serial casts for a few months at a time due to tight tendons caused by cerebral palsy- he used to get about ok- really didn't seem to bother him much. He used to have these sort of shoe things with velcro straps that went over the casts to stop them getting wet and make it easier for him to walk outside- it never stopped him playing outside at break-time.

Try not to beat yourself up too much. Hopefully the casts will sort the problem out.

Cross posts! MrsJamin

Have pmd you in more detail. Don't panic. Dd was 7 when treated this year with casting. She ha always toe walked. I felt awful as like you expected her to just grow out of it. She didn't and it started causing aggrevated hip pain etc.

3 weeks in cast. Minimal pain and discomfort and lots of speeches about heel toe movement when walking and DD hasn't looked back! She now walks normally albeit with very flat feet but she is wearing ballerina style shoes and hasn't been in pain since!

Oh sorry. I have dealt with serial casting for children with a different set of problems than toe walking and those problems are for much younger children. Didn't mean to imply that this wasn't unheard of in children of your DD's age group with her type of problem IYSWIM.

Don't feel guilty and I'm really sorry if I made you feel that way. I managed to miss my son's foot problems and it's part of my job!

More - you didn't make me feel bad, don't worry, nothing to be sorry about!

My son is getting his first casting tomarrow
Morning it is going to make for a tough summer
With all the swimming and water play going on our goal is to get to 90 percent bend