Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy

Serial casting to stretch the plantarflexors has been advocated for idiopat hic toe-walkers (ITW) and children with spastic cerebral palsy (CP), althou gh outcomes have not been well studied. Neuromuscular function and gait wer e examined in eight children with CP (mean age, 7.1 years) and eight ITW (m ean age, 7.5 years) casted for 3 to 6 weeks. Baseline comparisons indicated that children with CP produced lower isometric plantarflexor torques (p < 0.02) concomitant with marked co-contraction (p < 0.001), greater ankle mob ility (p < 0.02), and higher reflex excitability (p < 0.001) than ITW. Afte r casting, both groups increased dorsiflexion range (p < 0.001), decreased resistance to passive stretch (p < 0.005), and produced maximal plantarflex or torques in dorsiflexed positions (p < 0.001). Reflex excitability was re duced in CP (p < 0.05). Immediately postcasting, no children toe-walked, bu t two with CP resumed a digitigrade pattern 6 weeks later. Gait velocity an d stride length did not change (p > 0.05). Serial casting yielded positive outcomes that may be longer lasting in ITW.