a Site for Children with Cerebral Palsy

Toe Walking


Serial below the knee casting is used for correction of some contractures and muscle shortening of the Achilles group and with some elongation (growth, not stretch) of the hamstrings.

Solid fiberglass walking casts

Casts are also applied following surgical lengthening of the Achilles.

No crutches are used – in fact, not desired if the purpose is to gain or retain length of the posterior leg muscles.

Shown, are video frames grabbed at 1/30 second to show the heel contact as well as toe off portions of the walking cycle when black fiberglass casts were applied – in this case for idiopathic toe walking and acquired muscle shortening as a result of long term tip toe gait.

A heel contact is readily achieved along with good foot clearance and push-off or toe-off on the opposite side.

The use of below the knee solid fiberglass casts is NOT for immobilization of a broken bone. The casts are meant to be walked upon as long as appropriate sneakers are worn over the slippery fiberglass when a smooth floor is walked upon.

For kids with short muscles, sensory-motor dysfunction (dyspraxia), and obligatory toe-toe walking, a series of several casts is surprisingly successful.

The casts do not cause muscle atrophy.  In fact, there is generally some muscle hypertrophy or enlargement of anterior with posterior muscle groups combined.   Muscle strength with length!  Although the casts are below the knee, many of the youngsters hamstrings grow and elongate as well.  It is thought that the persistent traction on the muscle growth plates (musculotendinous junction) is what has been shown to be additional sarcomere (muscle cell) numbers.

Tendons have been unaffected and do not appear to stretch or grow while the child wears the casts.  Follow-up with basic, temporary AFOs in a manner similar to post-operative care; but without the surgery.

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