Your foot and ankle are the closest to the ground, making them crucial for basic skills like walking, standing, and weight shifting. The human foot has a total of 33 joints that work together to ensure stability and optimal weight-bearing. These joints also optimize muscle function and pull and, by extension, promote independence, safety, and efficiency as you move around within any environment. When your foot joints are improperly aligned, they could impact your muscle strength, range of motion, balance, and motor control. If your child suffers from a concern that minimizes the gross motor functions of the feet, we invite you to visit Suarez Physical Therapy. We serve Las Vegas, NV, and specialize in providing dependable intervention through Post-Botox Serial Casting.
Various concerns can impact your mobility. Problems like ABI (Acquired Brain Injury) can interfere with the ankle’s range of motion because of prolonged periods of immobility and an altered muscle tone. In children, this can affect their ability to stand, sit or walk. Through serial casting following Botox (Botulinum Toxin injections), we can restore a healthy range of motion within a shorter timeline and lower frequency of casting post injections.
Serial Casting Defined
Serial casting is one of the most effective methods of improving ankle range motion. It mainly targets bringing the toes up, also known as ankle dorsiflexion. Treatment involves using a series of casts that immobilizes targeted joints at a position of the cast. Because intervention is designed to work gradually and progressively, an ankle’s range of motion is gently increased with each cast used to stretch the joints and muscles.
With traditional methods of physical therapy, a practitioner focuses on manually stretching specific muscles or joints. Even though such methods bear the intended fruit, they don’t produce lasting alterations in muscle length. Research shows that the soleus (calf) muscle should be stretched for a minimum of 6 hours daily to ensure ongoing improvements in the ankle range.
During serial casting, a physical therapist creates a cast uniquely for your child. The cast is removed and reapplied, depending on the proposed recommendations. The models are designed to be comfortable and with a minimal load of resistance, making it easy to keep them on for days on end.
The effectiveness of serial casting is hinged on using a series of casts that maintain the ankle and foot in an optimal physiologic alignment. This minimizes the risk of your child feeling the “stretch.” With reliable intervention, therapy can improve range of motion, gait mechanics, and standing balance. It could also potentially prevent or delay the need for invasive treatments such as surgical orthopedic interventions.
Serial casting will allow your child to shift their weight onto the heels for improved balance. Proper lateral weight shifting increases their independence when walking, cruising, and standing and generally improves their safety when navigating different environments.
It remains imperative to note that the cast, in this case, is quite different from the traditional cast used to treat broken bones. While traditional casts aim to immobilize the affected areas, serial casting encourages activity. Your child can participate in walking and standing programs as part of treatment to gradually learn how to load weight onto the heels for improved balance and safety.
For maximum effectiveness of serial casting, your child should participate in physical therapy. We have qualified, experienced, and reliable physical therapists who take pride in providing excellent standards of assessment and treatment. Their training and clinical experience allow them to achieve the best possible outcomes, even when handling severe cases.
Understanding How Serial Casting Works
Serial casting is an effective method of enhancing the range of motion of joints that can’t flex or extend as far as they should. Often, such concerns arise when a limb is connected to at least one muscle that is either too tight or too short. By using a series of casts on the affected joint, each model will gently move the joint in question a little further until it is properly aligned.
The first cast will hold the joint in a manner that stretches the affected muscle just a little. After one week or so, your child will need a new model that will extend the joint a little further. With each week, your little one will receive a new cast to make the targeted muscle longer and increase its flexibility.
Dependable physical therapists fabricate casts that are well padded and provided ideal support for the fore, mid, and hind portions of the foot/ankle. The idea is to apply a fresh cast each week for the least number of weeks, depending on how much range of motion is achieved between castings. Typically, the length of treatment will depend on the severity of concern and how much a muscle needs to stretch to achieve the best outcome.
On average, serial casting treatments take 2 to 12 weeks. However, a more extended treatment plan may be necessary, especially with patients whose conditions have affected their nerves. Sometimes, treatment is more effective when physical therapists use Botox, applied by a neurologist or physiatrist. This is a muscle-relaxing medication that targets the muscle that requires stretching.
We will assess the new range of motion each time before applying a new cast. Because patients are different, it is challenging to predict the exact timeline required to achieve the best outcome. Reliable treatment should involve continuing with the casting process until the maximum gains in muscle length are achieved.
After serial casting, your child can retain the achieved muscle length gains by wearing appropriate bracing and nighttime splints. In some cases, bracing and nighttime splints are weaned and eventually no longer required. Ensure you also encourage home exercise programs to prevent the re-emergence of muscle tightness and achieve limb functional goals.
Is Serial Casting Ideal for My Child?
If your child walks on their toes or hyperextends the knees when walking, he/she may benefit from serial casting. Such concerns are often caused by the lack of a good range of motion at the ankle and knee joints. Serial casting is also an effective intervention for children whose range of motion limitations make them intolerant to braces or the use of standing support.
Serial casting intervention may be appropriate when addressing concerns related to:
- Spina bifida
- Cerebral palsy
- Idiopathic toe walking
- Traumatic brain injury
- Neurologic disorders causing hypertonia
- Muscular dystrophy
- Congenital abnormalities
- Limb spasticity in both children and adults
- Peripheral neuropathy
- Metatarsus adductus
- Stroke, etc.
Generally, serial casting intervention can come in handy when treating any condition that causes a limitation in range of movements / motion, tight or stiff muscles. Even though most people who seek this type of treatment are children, adults with tightened muscles caused by brain injury may also benefit from serial casting. Apart from the ankles, intervention can also target the wrists, elbows, or knees.
Botulinum toxin is also referred to as a “miracle poison.” This biological substance is a neurotoxin produced by a gram-positive anaerobic called bacterium Clostridium botulinum. It is commonly found in the intestinal tracts of animals, on plants, in soil, or water. Even though botulinum toxin is one of the most poisonous biological substances globally, the FDA approved botulinum toxin type A for various medicinal purposes.
Understanding the Benefits of Botox During Serial Casting
Botox can be used for cosmetic purposes such as reducing frown lines temporarily. It also aids in treating spasticity (muscle stiffness) and can be used to manage strabismus, also known as crossed eyes.
Botulinum-A Toxin can be purified and used safely to reduce muscle stiffness or tightness. Spastic muscles interfere with motor activities, which is a common symptom for concerns such as cerebral palsy. When medication cannot be directed to a particular area of muscle tightness, a physician can administer oral medications.
Injected Botox may be necessary when treating severe spasticity. Depending on the nature of your concern and the affected muscle groups, a practitioner may administer Botulinum Toxin B or Botulinum Toxin A. Both have similar side effects and work by blocking chemical signals between muscles and nerves to alleviate muscle contraction or tightening.
Some of the key benefits of using Botox during serial casting include:
- Decreased pain and discomfort in tight or stiff muscles
- Increased functional use of treated limbs
- Significantly enhanced gait pattern
- Improvement in range of motion and joint or muscle positioning
- Greater ease in stretching
- Better tolerance of braces
- Possible delay in the need for surgery (at least until a patient is older)
Unfortunately, Botox has some side effects. The good news is that these side effects are often brief and well-tolerated. They may include:
- Temporary weakness around the extremity where an injection site
- Brief general weakness
- Localized pain on the injected site
- Possible localized infection on the injected site
- If administered in the lower extremities (legs), the patient may fall due to local weakness and changes in the gait pattern and ankle position.
Who Is Not an Ideal Candidate for Post Botox Serial Casting?
While serial casting intervention works for most patients with spasticity, not all of them can reap the benefits of Botox during treatment. Botox injections block the nerve signals in the muscle, minimizing contraction and allowing the muscle in question to relax and stretch.
A physical therapist can stretch the tight or stiff muscle manually or recommend wearing a cast or splint. Lengthening a tight muscle naturally increases its range of motion.
When a neurologist or physiatrist administers Botox injections alongside physical therapy sessions, treatment may include:
- Manual stretches
- Serial casting
- Muscle strengthening exercises
- Fitting of braces and orthotics
- Practicing mobility and functional tasks
- Measuring the range of movement before and after Botox injections
For serial casting treatments to be effective, your physical therapist will educate you about the best stretches for the limb and help you get into a splinting regime or home exercise program. The expert will also train you on how to apply splints and braces after removing your cast. The idea is to address functional problems and ensure that your child achieves the set goals within the shortest time possible.
Before treatment begins, your physical therapist will assess whether you are a good candidate for Botox injections. If the following concerns are identified, then Botulinum Toxin cannot be administered:
- To pregnant or lactating mothers
- If immunization received within the previous week
- If you have a fever, cold, flu, or cough symptoms
- If immunization scheduled to be received within seven days following Botox injections
Whether your physical therapist can arrange administration of Botox injections alongside serial casting or not, the expert will continually assess the effectiveness of treatment. Using a goniometer, the expert can provide an objective record of the progress and improvements achieved.
If Botox injections are administered, the muscles will begin to relax, and this effect can last for 3 to 4 months. Patients must undergo intensive physical therapy to gain maximum improvement in range of motion and muscle length.
What to Expect During Post Botox Serial Casting
If your child is scheduled for post-Botox serial casting, it is crucial to understand what the process entails. An essential thing you should know is that your neurologist or physiatrist will inject Botox directly into affected muscle groups. Because the procedure involves administering multiple needle injections, the physician may use various methods to reduce pain, discomfort, and anxiety.
These methods include:
Ethyl chloride is a freezing spray applied on the site before injections. It prevents pain caused by injections or minor surgical procedures. The freezing spray also relieves deep muscle pain when using muscle stretching techniques.
Oral versed is a medication that is safe for children. It is used before a procedure, and it causes decreased anxiety, drowsiness, and amnesia (cause for forgetfulness) following a procedure. The medication takes effect within 20 to 30 minutes, and your physician will take vital signs before and after the process.
Items from Home
Most children have certain things that give them comfort. For instance, your child may have a favorite blanket, toy, or music. It is perfectly okay for parents to carry any items that may comfort their children during procedures.
Botox Injection Procedure
If you want the physician to give your child oral doses, the medication works best when administered before a procedure. Because this medication is not mandatory, parents must request it before the process begins.
Your physician will begin by cleaning the area that needs to be injected with Botox. A freezing spray is then applied to the targeted muscle groups.
Using a small needle, the physician will inject the target muscle groups with Botulinum Toxin. This process only takes a few minutes.
Before you can leave, you will receive a unique set of instructions. The physician will also inform you when to revisit the clinic for follow-up or a serial casting appointment with the physical therapist.
What to Expect After Botox Injections
Depending on the extent of the functional problem and the proposed treatment, the physician may recommend serial casting intervention or manual stretching of the stiff muscles or joints. Right after Botox injections, your child can resume normal activities, physical therapy treatments, and perform serial casting with his/her physical therapist after a week or two.
It is usual for physical therapists to recommend changes in a patient’s physical therapy program. This ensures your child meets specified goals within a specified period. Often, the outcome of Botox injections is evident within 3 to 4 weeks following injections. At this point, most patients attest to experiencing spasticity relief in the injected muscles.
The effects of Botulinum Toxin can last for about three months. After this, they begin to fade off over several weeks gradually. Another Botox injection session will be necessary to ensure the complete success of treatment. Note that it is perfectly safe to receive Botulinum Toxin injections in less than three months.
Irrespective of the positive changes you notice after post-Botox serial casting, it is imperative not to overlook the importance of attending follow-up appointments. They allow the physical therapist to document the effects and benefits of Botox injections and establish the most appropriate time for the subsequent treatment.
Physical therapy and Post-Botox Serial Casting
Before treatment begins, your physical therapist should conduct a comprehensive neurological assessment of your child’s functional problems, symptoms, and goals. This will help to establish the ideal intervention based on the specific needs and objectives of a child.
Some of the aspects a physical therapist will note include:
- The range of movement
- Muscle strength
- Sensation and proprioception
- Movement patterns
Neurological conditions, including spina bifida, muscular dystrophy, and cerebral palsy, are complex. This makes it imperative for parents to consider intensive physical therapy treatment coupled with serial casting intervention.
Physical therapy treatments focus on:
- Practicing functional tasks
- Myofascial Release / Massage
- Soft tissue stretches
- Strengthening exercises
- Muscle mobilizations
- Monitoring of skin integrity
Serial casting following Botox injections helps to maintain the gains in range of movement.
Find Suarez Physical Therapy Near Me
Serial casting is a critical component in providing a comprehensive plan of care for children with muscle stiffness or tightness. Often, patients achieve the set goals sooner when serial casting is combined with Botox treatments. Other interventions necessary to achieve the best outcome include balance training, strength training, whole-body vibration, bracing, gait training, and functional electrical stimulation (FES), just to mention a few. If you think your child may benefit from serial casting or post-Botox serial casting in Las Vegas, NV, reach out to Suarez Physical Therapy. We take a personalized care.experience approach to therapy and target the unique needs of each patient. Our team embraces the differences in different patients and will create a personalized program for your child based on medical assessments as well as your preferences. Contact us today at 702-368-6778 and let us help your child through the journey of gaining more functional use of his/her impacted limbs.