Serial casting for toe walking/ achilles heel surgery — The Bump
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Serial casting for toe walking/ achilles heel surgery


We saw an orthopedist today for the first time, to get another take on DS's toe-walking (DS just turned 2).  We have seen a physiatrist (2x) and DS gets weekly PT. Their approach has been "wait and see," since DS can come down from his toes, can dorsiflex and can go up stairs.  We have discussed the possibility f botox, or maybe AFOs. The physiatrist told me DS had some spasticity in his lower legs, and the heels/hamstrings were tight.

The ortho did NOT feel DS has spasticity; this dr believes (after watching DS walk up and down the hallway a couple of times, going up on his toes and coming down, and also after the exam), that DS has congenitally shortened Achilles heels.  He suggests we try casting (said botox won't do anything for DS since it can't lengthen muscles).  He also explained that in few years (after age 5), DS may need surgery.

Does anyone have any suggestions, or input, or experiences?


Re: Serial casting for toe walking/ achilles heel surgery

  • Yes, experience here! L had serial casting done in May/June and now has AFO's in camo. We've been dealing with tightened Achilles tendons most of his life, but in the last few years the flexibility isn't coming back after episodes with his other medical conditions. It sounds like he walks like L does.

    The casting is a little inconvenient, but it goes by fast. L did it for 6 weeks, 3 cast changes. Each cast change meant trying to get a better angle on the foot and then being static like that for 2 weeks. L did gain some flexibility, but it's stalled and we need to go see the orthopedist again about our options.

    I will say, bring an iPod or something with head phones, some of the younger kids in the casting room flipped out when the casting saw was on.

  • Your son may benefit from Bowen Therapy, please try to see if you can find an experienced practitioner in your area. Unfortunately it is almost always not covered by insurance. My son has made miraculous improvements although his issues were different.  Good luck!
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  • We always attributed Peyton's toe walking to her CP but since her tethered cord release she is rarely on her tippy toes.  
    DD1(4):VSD & PFO (Closed!), Prenatal stroke, Mild CP, Delayed pyloric opening/reflux, Brachycephaly & Plagiocephaly, Sacral lipoma, Tethered spinal cord, Compound heterozygous MTHFR, Neurogenic bladder, Urinary retention & dyssynergia, incomplete emptying, enlarged Bladder with Poor Muscle Tone, EDS-Type 3. Mito-Disorder has been mentioned

    DD2(2.5): Late term premie due to PTL, low fluid & IUGR, Reflux, delayed visual maturation, compound heteroygous MTHFR, PFAPA, Bilateral kidney reflux, Transient hypogammaglobulinemia, EDS-Type 3

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