Serial casting uses a sequence of well-padded casts, changed every one to two weeks, to slowly lengthen a tight muscle–tendon unit or improve a joint’s range of motion. Each cast holds the limb at its current end-range; over days the tissue accommodates, and the next cast captures a bit more correction. It is most often used at the ankle for a tight calf (equinus) — in toe walkers, cerebral palsy, and after some injuries — but the same principle is used at the elbow, knee, and wrist. It is a first-line, surgery-sparing option and is sometimes combined with Botox injections.
A therapist or orthopedic team applies a padded cast with the joint held at its comfortable end-range. It stays on for one to two weeks, then is removed and replaced with a new cast capturing the improved position. The cycle repeats — usually a few casts — until the target range is reached, often followed by a brace (AFO) or night splint to hold the gains.
No surgical recovery — the child usually walks in the cast. After the final cast, a brace or splint and stretching help maintain the correction. Skin is checked at each change to avoid pressure sores.