A Critical Evaluation of the Updated Evidence for Casting for Equinus Deformity in Children with Cerebral Palsy

Abstract

Recent years have offered little progress in the state of evidence for casting in the management of equinus deformity. Casting appears to offer at least short-term improvement in ankle dorsiflexion, although the proposition that this improves function or avoids surgery is not well substantiated. Future research needs to ensure more robust study design and broader evaluation across domains of the International Classification of Functioning, Disability and Health to determine the functional and long-term effect of casting for equinus deformity. Greater knowledge is required of the effect of casting on muscle structure and function in spastic CP. Copyright © 2015 John Wiley & Sons, Ltd.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

“…Emergent evidence suggests that changing the casts at 3-day intervals rather than weekly intervals can shorten the total duration of the casting series and thus lower the amount of weakness induced. After casting, active strength training [60] (green light) and goal-directed training [98] (green light) are recommended to make functional use of the new range gained. (d) Once a contracture is severe (e.g., greater than 20°) and longstanding, casting will no longer be sufficient in isolation, and orthopedic surgery requires consideration.…”

Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with Botulinum NeuroToxin‐A, serial casting, and physiotherapy

“…In such a combined treatment approach, it is presumed that after decreasing muscular activation with BoNT‐A, serial casting of muscles at an extended length stimulates the addition of sarcomeres in series, increases their lengths, and reduces their stiffness . Currently, human models that substantiate these working mechanisms do not exist …”

“…3 Currently, human models that substantiate these working mechanisms do not exist. 4,5 Increases in ankle joint range of motion (ROM) in SP after BoNT-A and serial casting have been reported. [6][7][8] In routine clinical assessment, this ankle joint ROM is determined by examining the angle between the foot sole and the shank.…”

Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children

“…These findings may be of great clinical relevance as most neuromuscular deficits associated with gait impairments are treated at the muscle-tendon level in children with SCP [2,47] . Subsequently, widely used treatments such as muscle-tendon lengthening, [48] botulinum neurotoxin type A injections, [29] casting, [30] prolonged orthotic use, [27] chronic stretching, [49] and different types of strengthening interventions [50] generate muscle-tendon adaptations which may in turn affect function. For example, despite functional gains outweighing muscle atrophy, prolonged use of ankle-foot braces has been shown to decrease fascicle length and reduce late stance ankle moment generation.…”

“…A convenience sample of children with SCP was obtained from those who visited the movement analysis laboratory of our hospital for a routine gait analysis and met the following inclusion criteria: diagnosed SCP; hemiplegic or diplegic; independently ambulant GMFCS I-II; no previous orthopedic or neuro-surgery [10] ;no botulinum neurotoxin type A injections [29] or casting [30] 6 months prior assessment; and within 5 to 12 years of age. [15] This age range was selected as MG length has been linearly associated to tibia length within this range.…”