AIM: To study the effects of single versus serial casting post-Botulinum Toxin A (BoNT-A) injections on hypoextensibility of triceps surae in children, 2 to 7 years old, with cerebral palsy and equinus gait. METHODS: A randomized, stratified, parallel, two-group trial was conducted at a pediatric health center with assessments at baseline, precast, postcast and, 1-, 2-, and 6-month follow-ups. One week following BoNT-A injections into triceps surae muscle, a single below-knee cast (n = 10) or 3 serial casts (n = 10) were applied for 3 weeks. Primary outcome measure was the Modified Tardieu Scale (MTS), secondary outcome measures were Modified Ashworth Scale (MAS), GAITRite, Gross Motor Function Measure-66 (GMFM-66), and Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: Significant effects of time, but not group-by-time, were found for MTS R1 (p < 0.001), MTS R2 (p < 0.001), MAS (p = 0.001), GMFM-66 (p = 0.002), and PEDI (p < 0.001 to 0.009). One participant who received a single cast did not complete the 6-month assessment. CONCLUSIONS: Magnitudes of improvements were similar using single or serial casting. If these findings are corroborated in a larger scale study, the recommendation of a single cast may be appropriate due to its greater convenience for families and clinicians.
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