What Is Serial Casting?

If your child has a joint that can’t flex or extend as far as it should, that might be because one of the muscles connected to it is too short or tight. Your doctor may recommend putting a series of casts on the joint. Each one would turn the joint a little farther in the direction it needs to go.

You may hear this technique called serial casting, and doctors mainly use it on wrists and ankles. It might help your child walk better or gain better use of his hands and arms.

Serial casting can sometimes help adults, too.

How It Works

The first cast holds the joint in a position where it stretches the muscle just a little. A week or so later, your child’s medical team puts a new cast on him. This one turns the joint a little more, so that it pulls the muscle farther. Each week, a fresh cast increases the stretch.

When the muscle gets stretched over a period of weeks, it adds cells that make it longer and more flexible.

How long this takes depends on how much the muscle needs to expand. The average time is around 4 to 6 weeks. If your child needs serial casting because of a condition that affects his nerves, he might need more than one round of it.

Sometimes, people also get shots of Botox, a muscle-relaxing medication, to target the muscle that’s getting stretched.

Who It Helps

Serial casting can benefit kids affected by:

Serial casting may also help adults whose muscles have tightened after a brain injury. The process has helped people get more motion in their elbows, wrists, knees, and ankles. For them, switching the casts every few days works better than waiting a whole week each time.

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How the Casts Go On and Come Off

Each cast is made of fiberglass. Cotton and padding go between it and your child’s skin.

It could take around an hour to put on the cast. The medical team may need around double that time if they also give your child a shot of Botox.

If the cast goes on your child’s foot, he may also get a special sock and shoe to help him walk. But he’ll have to wait at least 2 hours after he gets the cast before he puts his weight on it.

When the time comes to take off a cast, the doctor will probably use a tool with a blade that vibrates quickly back and forth. Your child should only feel a tickling sensation and a little warmth.

Some casts are so easy to remove that the medical team may ask you to take off each one just before you bring your child back for the next one.

What to Consider

Serial casting comes with both advantages and challenges. The pluses are:

  • It spares your child from having an operation.
  • The casts don’t cause pain.
  • It can be repeated if need be.

The challenges:

  • It takes several weeks.
  • Some muscles may get weaker for a while.
  • You and your child have to be very careful not to get the cast wet.

Dos and Don’ts

Your child may need a little time to get used to the weight and bulk of the cast. But he can walk around, go to school, and do his regular activities. It’s good for him to stay active.

Meanwhile, keep these things in mind:

The cast must stay dry. This is the most important of all. If the lining gets wet, it can blister or irritate your child’s skin. When it’s time for a bath, he could take sponge baths, or else hold the cast outside the tub. Or before he gets in the tub, wrap the cast in plastic wrap, then put a plastic bag over that, then another layer of plastic wrap.

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Don’t try to scratch. The cast is snug and warm, and it doesn’t let dead skin cells fall away. So your child will probably itch sometimes underneath it.

Never stick anything into the cast to scratch. Instead, try to keep that part of your child’s body dry and cool. An ice pack or fan might help. Or you could put a hair dryer on the cool setting and blow air into the cast. If the itching is bad, you could ask your doctor if it’s OK to try an over-the-counter medicine like Benadryl.

Keep dirt out. When your child is outdoors or being active, slip a sock over the cast for protection.

Be ready for soreness. Your child might get sore from going around with the extra weight and bulk of the cast. An over-the-counter pain reliever like acetaminophen or ibuprofen (Advil, Motrin, Nuprin) could help.

After the Last Cast

The treatment might not be over, but different.

Your child may need to use a brace or splint. The medical team may give him a removable cast to wear at night.

Also, your child will probably need to get physical therapy. If the therapist gives him exercises to do at home, encourage him to stick with them. If he needs to get used to his new and better way of walking, his physical therapy may last several months.

WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on March 07, 2020

Sources

SOURCES:

Children’s Hospitals and Clinics of Minnesota: “Serial casting fact sheet.”

United Cerebral Palsy of Greater Cleveland: “LeafBridge Serial Casting Clinic.”

Riley Children’s Health: “Serial Casting.”

Physical Therapy: “Serial casting for the management of spasticity in the head-injured adult.”

Mayo Clinic: “Toe walking,” “Peripheral neuropathy,” “Spina bifida,” “Botox injections.”

Archives of Physical Medicine and Rehabilitation: “Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study.”

Cincinnati Children’s: “Serial Casting -- Cast Application.”

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