Clinical Bottom Line
“How should I apply this information?”
Traditional interventions to address equinovarus contractures in boys with Duchenne muscular dystrophy (DMD) have included orthopedic surgery, orthotics, corticosteroids, and stretching. These interventions have provided variable benefits for prolonged standing, ambulation, balance, and function; however, ankle contractures continue to impede this population. This study used serial casting to increase passive range of motion in ankle dorsiflexion. Serial casting has been used effectively in children with cerebral palsy and may also be an effective intervention for improving range of motion in boys with DMD.
The results of this retrospective study showed that serial casting was statistically significant for improving dorsiflexion passive range of motion in boys with DMD. The authors selected 3 timed outcome measures to detect any changes in function. No significant differences were found in comparing the timed measures, indicating that these boys did not lose function during or after the casting program. A negative correlation between age and range of motion per cast was reported, meaning that younger children demonstrated faster improvements in ankle dorsiflexion range.
Serial casting can be an effective method for increasing ankle dorsiflexion and decreasing equinovarus contractures in boys with DMD. Importantly, the immobilization of the ankle during casting should not result in significant loss of speed or function. Compared with the costs of surgery or custom orthotics, this approach of serial casting should be considered among effective interventions for boys with DMD.
“What should I be mindful about in applying this information?”
Since this was a retrospective study with a small sample size, additional studies may be warranted to confirm these positive results. The casting methods are clearly explained in the article, but the number of casts varied with each child between 2 and 5 (mean of 3) casts to achieve these results. The improved speed with which range increased in younger boys suggests that the number of casts may increase for older boys. In the younger boys, there may be a need to repeat the intervention again as they grow and the disease progresses. Despite the need for additional research, serial casting could be an appropriate conservative intervention for increasing range and maintaining function in boys with DMD.
Erin Kinsey, PT, DPT
JFK Partners, School of Medicine, University of Colorado
Mary J.K. Rapport, PT, DPT, PhD
Physical Therapy Program, School of Medicine
University of Colorado, Aurora, Colorado