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

2. 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

3. Serial Casts
2009
MP Haynes, MR Franjoine

4. Bivalved Cast
2009
MP Haynes, MR Franjoine

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. Botox: A Botox blocks the nerve from releasing acetylcholine
2009
MP Haynes, MR Franjoine

12. Orthotics / Splints
2009
MP Haynes, MR Franjoine

13. 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

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

15. Stabilizing Foot Splints
2009
MP Haynes, MR Franjoine

16. 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

17. Dynamic Ankle Foot Splints
2009
MP Haynes, MR Franjoine

18. Dynamic Ankle Foot Splints
SMO
Splints:
Sure Step
DAFO # 3½, 4, 5,
DAFO 3
Hinged DAFO
DAFO 3 1/2
Cascade
2009
MP Haynes, MR Franjoine

19. 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

20. 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

21. 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

22. Anti-Crouch Splint
2009
MP Haynes, MR Franjoine

23. 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

24. 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

25. 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):
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:
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

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