Lower Extremity Casting and Splinting Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine PT, DPT, MS, PCS

Common Foot Deformities Flexible pes planus = pronation Functional equinus = limitations in ankle range (dorsiflexion) Equino valgus= equinus and pronation Equino varus= equinus and supination Crouch deformity=weakness in plantarflexors 2009 MP Haynes, MR Franjoine

Serial Casts 2009 MP Haynes, MR Franjoine

Bivalved Cast 2009 MP Haynes, MR Franjoine

Serial Casting …. Purpose Regain & ↑ extensibility in soft tissue surrounding casted joint Sarcomere reorganization Hypoextensibility: Tardieu Imbalance of agonist/antagonist Dysfunction in growth regulation 2009 MP Haynes, MR Franjoine

Serial Casting …. Purpose Influence Equinus Position (foot): Gastrocnemius Influence Crouch Position Hamstrings Goal /Outcome: Range: ↑ dorsiflexion (5º-10º) Function: + change gait pattern Prepare foot for splints 2009 MP Haynes, MR Franjoine

Serial Casting.... Process Cast wear: Cast application process Below knee for gastroc length Above knee for hamstring length Length of cast wear Number of cast applications Indications Contraindications 2009 MP Haynes, MR Franjoine

Serial Casting used in combination with Botox Injections Often see… Serial Casting used in combination with Botox Injections 2009 MP Haynes, MR Franjoine

Botox Injections Acts as Neuromuscular block at neuo-motor junction Produces selective denervation to specific muscles and nerves ↓ force of agonist muscle contraction Allows expression of antagonist muscles 2009 MP Haynes, MR Franjoine

Casting and Botox Is Botox injections used in conjunction with serial casting beneficial? Aiona Yes Booth No Kay If so, what is the best combination for use 2009 MP Haynes, MR Franjoine

Botox: A Botox blocks the nerve from releasing acetylcholine www.botox-info.com 2009 MP Haynes, MR Franjoine

Orthotics / Splints 2009 MP Haynes, MR Franjoine

Purpose of splints …. Function Protection of cartilaginous, soft tissue & weak muscle groups Provides optimal joint alignment with least restrictions Allow maximal joint movement possible improving stance & gait Function 2009 MP Haynes, MR Franjoine

Stabilizing Foot Splints Purpose …. Provides control frontal plane: eversion/inversion Foot plates, heel cups, hot dogs 2009 MP Haynes, MR Franjoine

Stabilizing Foot Splints 2009 MP Haynes, MR Franjoine

Stabilizing Foot Splints/Orthotics When use splints successfully? Mild foot deformities Keep subtalus & midtarsal joints in alignment Indications Contraindications Fixed contractures in peroneals, gastrocs, posterior tibialis & functional equinus Treatment ideas 2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot Splints 2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot Splints SMO Splints: Sure Step DAFO # 3½, 4, 5, http://www.surestep.net/ DAFO 3 Hinged DAFO DAFO 3 1/2 Cascade http://www.dafo.com/ 2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot Splints/ Orthotics Purpose …. Provides control SMO: Control in frontal plane /allows sagital plane motion AFO/DAFO: Control in frontal plane with some sagital plane stability 2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot Splints When use these splints successfully? Manage equinus deformity Severe pes plantus Indications Ready to ambulate Adequate range (10-15º Contraindications Fixed contracture Crouch problem ?? Treatment Ideas 2009 MP Haynes, MR Franjoine

Solid Ankle Splints Purpose Indications Contraindications Standing Night splinting Knee hyperextension Indications Protect foot in standing program Following Surgery Contraindications Interferes with functional activities 2009 MP Haynes, MR Franjoine

Anti-Crouch Splint 2009 MP Haynes, MR Franjoine

Anti-Crouch Foot Splints Purpose: Supports STJ & keeps calcaneus in mid-position Keeps tibia from falling forward over plantigrade foot (muscle weakness / surgery overlengthening) Blocks excessive ankle & knee flexion 2009 MP Haynes, MR Franjoine

Anti-Crouch Foot Splints Indications Excessive weakness Excessive dorsi flexion Increased knee flexion Contraindications Knee hyperextension Contractures: hamstrings / hip flexors Treatment Ideas 2009 MP Haynes, MR Franjoine

Bibliography Booth MY, Yates CC, Edgar TS, Bandy WD. Serial casting vs combined intervention with botulinum toxin A and serial casting in the treatment of spastic equines in children. Pediatr Phys Ther. 2003;15(4):216-220 Kay RM, Rethlefsen SA, Fern-Buneo A, et al. Botulinum Toxin as an Adjunct to Serial Casting Treatment in Children with Cerebral Palsy. The Journal of Bone and Joint Surgery (American). 2004;86:2377-2384 Aiona M, Sussman MD. Treatment of spastic diplegia in patients with cerebral palsy: Part II. Journal of Pediatric Orthopaedics B.2004; 13(3):1-43. See separate Splint Orthotics Reference 2009 MP Haynes, MR Franjoine

Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS Jan McElroy, PT, MS, PCS 2009