Lower Extremity Casting and Splinting

Margo Prim Haynes, PT, DPT, MA, PCS

Mary Rose Franjoine PT, DPT, MS, PCS

2009 MP Haynes, MR Franjoine

Common Foot Deformities

Flexible pes planus = pronationFunctional equinus = limitations in ankle

range (dorsiflexion)Equino valgus= equinus and pronationEquino varus= equinus and supinationCrouch 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 reorganizationHypoextensibility: Tardieu

Imbalance of agonist/antagonistDysfunction in growth regulation

2009 MP Haynes, MR Franjoine

Serial Casting …. Purpose

Influence Equinus Position (foot):Gastrocnemius

Influence Crouch PositionHamstrings

Goal /Outcome:Range: ↑ dorsiflexion (5º-10º) Function: + change gait patternPrepare foot for splints

2009 MP Haynes, MR Franjoine

Serial Casting.... Process

Cast wear: Cast application process

Below knee for gastroc lengthAbove knee for hamstring length

Length of cast wearNumber of cast applications

IndicationsContraindications

2009 MP Haynes, MR Franjoine

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 ….

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

frontal plane: eversion/inversion

Purpose …. Provides control

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

alignmentIndicationsContraindications

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

Splints:

DAFO # 3½, 4, 5, DAFO 3

DAFO 3 1/2

Hinged DAFO

Cascade http://www.dafo.com/

Sure Step

SMO

http://www.surestep.net/

2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot Splints/ Orthotics

SMO: Control in frontal plane /allows sagital plane motion

Purpose …. Provides control

AFO/DAFO: Control in frontal plane with some sagital plane stability

2009 MP Haynes, MR Franjoine

Dynamic Ankle Foot SplintsWhen use these splints successfully?

Manage equinus deformity Severe pes plantus

IndicationsReady to ambulateAdequate range (10-15º

ContraindicationsFixed contractureCrouch problem ??

Treatment Ideas

2009 MP Haynes, MR Franjoine

Solid Ankle Splints

PurposeStandingNight splintingKnee hyperextension

IndicationsProtect foot in standing programFollowing 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-positionKeeps 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

IndicationsExcessive weaknessExcessive dorsi flexion Increased knee flexion

ContraindicationsKnee hyperextensionContractures: 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

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

Jan McElroy, PT, MS, PCS2009