Serial casting for HSP

May help with pain and spasticity


Serial casting
Serial casting

Serial casting of the right foot of an adolescent girl with HSP resulted in a reduction in pain and spasticity, and improved flexibility, with the results persisting for more than a year.



The purpose of this report is to explore assessment and serial casting intervention for painful rigid flatfoot deformities with vertical talus in an adolescent girl with hereditary spastic paraplegia who was nonambulatory.


The participant’s right foot underwent 2 phases of casting with correction first toward hindfoot inversion and then dorsiflexion. Because of a vertical talus, her left foot required an intermediate casting toward plantar flexion, inversion, and forefoot adduction prior to casting toward dorsiflexion.


The patient improved despite the underlying progressive neuromuscular disorder. Pain ameliorated and she returned to supported standing and transfers. Spasticity decreased bilaterally and the flexibility of her foot deformities improved to allow orthotic fabrication in subtalar neutral. Results were maintained at 12 and 16 months.


Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.


SOURCE: Pediatr Phys Ther. 2014 Summer;26(2):253-64. doi: 10.1097/PEP.0000000000000023. PMID: 24675132 [PubMed – in process]

Serial casting for neuromuscular flatfoot and vertical talus in an adolescent with hereditary spastic paraplegia.

Sweet LA1, O’Neill LMDobbs MB.

1Department of Children’s Services (Dr Sweet and Ms O’Neill), United Cerebral Palsy of Greater Cleveland, Cleveland, Ohio; University of St. Augustine for Health Sciences (Dr Sweet), St. Augustine, Florida; Department of Orthopedics (Dr Dobbs), Washington University School of Medicine and St. Louis Children’s Hospital, Saint Louis, Missouri.



  1. This was done on my daughter when she was three and before her diagnosis of HSP. She was in the casts for 8 weeks and they were changed every 2 weeks. It caused a massive amount of weakness in her calves and feet she has never regained. It may have had something to do with her age.

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