Cerebral PalsySerial Casting in Idiopathic Toe-Walkers and Children with Spastic Cerebral PalsyBrouwer, B. Ph.D.; Davidson, L. K. M.D.; Olney, S. J. Ph.D. Author Information Study conducted at the School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada From the School of Rehabilitation Therapy, Queen's University; *Department of Orthopedic Surgery, Hotel Dieu Hospital, Kingston, Ontario, Canada. Address correspondence and reprint requests to Dr. B. Brouwer, School of Rehabilitation Therapy, Louise D. Acton Building, Queen's University, Kingston, Ontario, Canada K7L 3N6. E-mail: [email protected] post.queensu.ca Journal of Pediatric Orthopaedics: March 2000 - Volume 20 - Issue 2 - p 221-225 Buy Abstract Summary: Serial casting to stretch the plantarflexors has been advocated for idiopathic toe-walkers (ITW) and children with spastic cerebral palsy (CP), although outcomes have not been well studied. Neuromuscular function and gait were examined in eight children with CP (mean age, 7.1 years) and eight ITW (mean 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 mobility (p < 0.02), and higher reflex excitability (p < 0.001) than ITW. After casting, both groups increased dorsiflexion range (p < 0.001), decreased resistance to passive stretch (p < 0.005), and produced maximal plantarflexor torques in dorsiflexed positions (p < 0.001). Reflex excitability was reduced in CP (p < 0.05). Immediately postcasting, no children toe-walked, but two with CP resumed a digitigrade pattern 6 weeks later. Gait velocity and stride length did not change (p > 0.05). Serial casting yielded positive outcomes that may be longer lasting in ITW. Copyright © 2000 Wolters Kluwer Health, Inc. All rights reserved.