Serial Casting for toe walking

Our story:
My son Leyton has been a “toe walker” from the day he started walking. At first it was really cute, but as the years past I made a point to ask the doctor about it. Every year they would ask if it was all the time and I would say 99% of the time and they would say, “as long as he can stand on his heals he is fine.” But he’s not fine. Walking on his toes makes him fall more, makes his feet really hard and muscular, makes his toes stretch out, makes his muscles tight, it’s causing him to lose flexibility/mobility…and it can lead to ankle, knee, hip and back problems in his adult life.

So, we’re doing something about it.

Today we went to Children’s Hospital in St. Paul, MN to start a 8-12 week process of Serial Casting for toe walking.

What is toe walking? Toe walking is a diagnosis in which a person walks with bilateral toe-to-toe walking pattern.  There may be a medical cause or it may be idiopathic in nature. (my definition: he looks like he is walking on his tippy toes all the time)

How does Children’s treat patients who toe walk? 

  • We offer serial casting, orthotic intervention, and physical therapy treatment for treatment of toe walking.
  • Serial casting has been proven to be an effective intervention for toe walkers in treatment of tight heel cords to increase the range of motion and to also weaken the heel cord muscle to allow us to re-train the child’s walking pattern.
  • Children’s and Orthotic Care Services have designed a new type of solid ankle foot orthotic that mimics serial casts for treatment of toe walking.
  • The orthotic brace is a two-pull carbon fiber solid ankle foot orthotic.  The carbon fiber on the outer shell decreases the amount of multi-planar ankle motion that is available which mimics the effects of serial casting through increasing range of motion through the heel cords as well as weakening the heel cords but allows the child more flexibility in that they can take off the brace to shower or participate in certain activities.
  • After serial casting or carbon fiber bracing intervention has been completed, children are then placed in a two-pull plastic ankle foot orthotic to re-train their gait pattern to allow for a consistent heel-toe walking pattern.

Is this how I want him to spend his summer? No, I don’t, these casts can’t get wet. But, he has a great attitude about it so I will too. I’m going to invest in heavy duty plastic bags and double sided medical tape so that he won’t miss out on anything! And we’re going to figure out fun new things to do in St. Paul…since we’ll be driving there every week to change the old cast for a new one. I’m thankful to live in a country that provides such incredible care for my sweet son.

How do I feel? I have a lot of emotions, but I’m trying to keep perspective. The mommy heart in me hurts for my son.

Sad that he has to struggle, but happy that it won’t be his whole life.

Bummed that my son needs to be in casts for 8-12 weeks, thankful that we have the medical coverage that provides it.

Grieved that I can’t stop this pain, grateful I have the privilege of walking with him through it.

During our appointment she asked a great question. “Why does he toe walk?” (I’m all about figuring out root causes for things so this conversation was really helpful.) They have done studies linking sensory issues, genetic tightness of that muscle, and other neurological reasons. Leyton is an extreme happy-go-lucky child…it was interesting to separate what I always thought was his personality and what may be toe walking related. We will learn as we go. He is worth it!

I’d love to hear from anyone who has gone through this process…please comment.

Cheri - June 13, 2014 - 2:13 pm

My daughter went through it a couple of years ago, in second grade. We did casts in December, and she only had to have those on for a couple of weeks (we got red and white striped ones so her legs looked like candy canes). She was then in orthotic braces for the next several months–the hardest part was finding shoes that fit over them. Maybe with a boy that will be easier….

We gradually tapered off the braces over the next several months. It’s amazing! She’s had a normal gait with HUGE improvements in flexibility since then. Our doctor warned us that she may revert to toe walking a little bit with any big growth spurt but so far we’ve seen no signs of that, thank goodness.

Best wishes to you and Leyton on this journey!

Noemi - June 13, 2014 - 2:26 pm

I’m praying for the same success for my son! Every story I hear encourages me…thank you!

tasha - June 13, 2014 - 9:14 pm

You are such a good and beautifully loving Mommy! I’ll be praying for you all! <3

Jen - June 13, 2014 - 11:32 pm

Hey Noemi
If you want to talk to a mom in the area that has gone through it. Kim my sister is in Apple Valley. Sometimes it helps to talk to someone who knows exactly how you feel to process and ideas for Layton 🙂 keep us posted! Miss you!

Noemi - June 14, 2014 - 6:31 am

Love you Tash! Thank you.

Noemi - June 14, 2014 - 6:31 am

I don’t have any questions right now but I might…I’ll let you know for sure.

Rachel - August 21, 2014 - 10:33 pm

Noemi, I just started serial casting with my 6 year old son, at Children’s Minneapolis. I would love to hear how the process is going for you and Layton. I stumbled across this post when doing a google search on the orthotics. When your face and name popped up, you looked familiar to me for some reason. I just figured out that you are friends with Annette, who has posted about you on FB. Fun connection. My daughter and I went to Thailand with her, before she was married. I feel in need of a bit of encouragement, because I did not realize that the process was going to take months after the serial casting. Somehow that did not get across when we talked to the physical therapist initially. Sigh. I hope that your son has made great gains already and that you are feeling that it has been worth the effort. In the trenches with you, Rachel

Noemi - August 22, 2014 - 7:33 am

Rachel…it is a long journey. But the one thing I have learned from this summer of appointments, doctors, and being diagnosed…I have fallen more in love with my son. Focusing on him has made me learn who he is. I love him more and I’m excited for the OT and PT ahead. It’s hard work but he’s worth it.

laurie - March 20, 2017 - 7:24 am

Hi Moms of toe walkers from 2014!

If anyone receives this, we are considering serial casting this September or January for our then 6 year old daughter who has mild spastic right hemiplegia. She hates wearing an AFO. And we are looking into this as an option to help her. Any comments or thoughts about the process would be appreciated. We will be going to Luries Childrens Hospital in Chicago to have it done.

Thank You!

Noemi Hedrick - May 22, 2017 - 2:34 pm

How did it go? Did you decide to get the casts?

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