Adherence to serial casting protocols for idiopathic toe walking: A quality improvement initiative

Karina A. Zapata, Megan E. Trevino, Fabiola I. Reyes, Chan Hee Jo, Charu Sharma

Research output: Contribution to journalArticlepeer-review


PURPOSE: This initiative aimed to assess adherence to Scottish Rite for Children's serial casting protocol for children with idiopathic toe walking (ITW), factors related to adherence, and outcomes after education regarding the protocol. METHODS: 60 patients aged 7.1±2.7 years who completed serial casting were examined at baseline phase (n = 30) and post-education phase (n = 30). Protocols include weekly serial casting for 4 to 6 weeks to achieve 10° of ankle dorsiflexion (ADF) passive range of motion (PROM) with knees extended (KE), assessing the foot posture index (FPI-6) and single leg stance (SLS). Baseline phase evaluated adherence to protocols. Education phase evaluated factors related to adherence and education regarding serial casting findings. Post-education phase evaluated the impact of the education phase. RESULTS: Serial casting averaged 4.8±1.5 weeks (n = 60). ADF PROM was measured with 100% adherence. ADF PROM KE averaged-10.7° pre-cast and significantly improved to +6.5° post-cast (n = 60), and it significantly improved post-cast post-education (p = 0.04). FPI-6 and SLS adherence significantly improved post-cast post-education. FPI-6 total score averaged +5.3 at baseline and +5.8 post-cast (n = 35). CONCLUSION: Education of staff in serial casting protocols improved adherence and patient outcomes. Patients with ITW and ADF PROM KE-10° benefit from serial casting to improve PROM and to allow for orthotic use post-casting.

Original languageEnglish (US)
Pages (from-to)469-476
Number of pages8
JournalJournal of Pediatric Rehabilitation Medicine
Issue number3
StatePublished - Sep 6 2022
Externally publishedYes


  • dorsiflexion
  • foot posture index
  • FPI-6
  • ITW
  • QI

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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