Serial Casting After Botulinum Toxin Injection

Your medical provider may recommend casting to provide stretching and enhance the effect of Botox© treatment. “Serial Casting” is a series of casts that are applied approximately one to two weeks apart to create a continuous stretch to the extremity and gradually increase the range of motion. This is usually done for improving motion in the ankle area, but can also be done to the knee, elbow, or wrist and finger joints. 

The first cast is usually applied one or two weeks after the Botox© has been given. This allows the Botox© to begin its work reducing the tightness of the muscle. Each cast will be left on for about one to two weeks. When it is taken off, your provider will check the progress in range of motion. It is also a good time to check skin condition. When enough has been gained in motion and position, the cast will be discontinued. The usual casting period is four weeks. 

Walking activities are encouraged because they help the “stretch”. The cast is made of fiberglass so it is lightweight. The bottom of the foot will be shaped so it can be walked on comfortably. You will receive a special rubber soled sandal to wear for walking.

You may plan to continue all of your normal activities except swimming or bathing. The cast will lose its strength and may break if it gets wet. 

Your provider will tell you when your casting can be stopped and will probably order a brace or a plaster splint that can be taken on and off. The brace or splint is worn at night and during a portion of the day for a total of 16 to 23 hours each day. This will help maintain the motion that was gained with the Botox and the casting.

Sometimes soreness occurs in the tendon and muscle area. This is caused by the stretching and becomes obvious when the cast support is taken away. It is usually mild and will go away within a week. The following comfort measures may be helpful: 

• Motrin (or children’s Motrin) several times a day 
• Tylenol (or children’s Tylenol) several times a day 
• Warm soaking baths 
• Rest the extremity for a day and then gradually resume activities 
• Check the fit of the brace to see if there are any pressure areas that should be relieved 

Sometimes the soreness persists or becomes intolerable. Your provider might recommend a higher dose of Motrin. It is also possible to have a cast put back on for a week or two to give the extremity rest and support. 

Please contact Telehealth Nursing at 651-229-3890 if you have any questions.  Be sure to call if your child has severe pain from the cast, or circulation and ability to wiggle the toes is affected.