Serial Casting

Also known as: Physical therapy serial casting.

What is serial casting?

Serial casting is a conservative, non-invasive alternative to surgery aimed at increasing the range of motion of tight ankle muscles and joints through a series of brief consecutive leg cast applications and removals. With each successive cast, the ankle joint is gently set in progressively increasing increments of the desired range of motion.

During the time the cast is applied, the shortened tissues physiologically adapt to the reduced demand for postural maintenance, and to the gentle, prolonged elongation of the shortened muscles. Serial casting is used to increase dorsiflexion (range of motion) in children with central nervous system (CNS) dysfunction, and for children with idiopathic toe walking.

The method and materials used in this program allow for the parent to remove the casts at home, thereby reducing the cost of cast removal and avoiding use of a cast saw commonly used in clinical settings. The noise of the saw can be a source of concern for some children. During serial casting, children can continue most regular daily activities. Sneakers modified in the clinic are used over the casts to support the child’s mobility during treatment, with the added benefit of having the child’s ankle in the proper alignment during their activities and during their physical therapy sessions.  

How can physical therapy serial casting help?

During serial casting, joints that are limited in range of motion are immobilized with a well-padded soft fiberglass cast. The casts are applied and removed on a weekly basis. With each series of casts, the affected joint or joints are gradually set in a more correct alignment until the desired range of motion is achieved.

The casts provide a stable base of support while realigning joints, enabling strengthening of muscles and teaching children how to correct their center of weight for a more effective walking pattern.

We encourage children to participate in their typical daily activities while wearing the casts. Regular movement helps strengthen muscles needed for correct walking alignment. We also ask that children complete at least an hour a day of standing or walking exercises. This hour can be divided into smaller time periods. Your physical therapist will give you specific exercises tailored to your child's specific needs.

Who can benefit from physical therapy serial casting?

• Cerebral palsy
• Brain injury
• CNS dysfunction
• Congenital abnormalities
• Idiopathic toe walking
• Muscular dystrophy

How much time does serial casting treatment require?

The total amount of casts serially applied depends on each child's response to the casting and to the severity of the tightness of the muscle. In general, a series of 4 to 6 casts is needed to achieve the necessary range of motion. Each cast in the series is typically worn for about a week.

How to make a physical therapy serial casting appointment

To schedule your initial physical therapy evaluation for serial casting, please contact 877-255-8437. Appointments can also be scheduled online. Services are provided at our Nicklaus Children’s Outpatient Centers in Doral, West Kendall, Weston (Dan Marino Center) and Palm Beach Gardens.

This page was last updated on: August 31, 2026 03:20 PM