A UNIVALVE CAST ALTERNATIVE TO CONSERVATIVELY MANAGE ANKLE RANGE OF MOTION IN A PATIENT WITH AUTISM AND IDIOPATHIC TOE WALKING

Background: While serial casting is an effective method for managing limited ankle dorsiflexion in children with idiopathic toe walking (ITW), some children are unable to tolerate full-time casting. Autistic children have a higher incidence of surgical intervention for limited range due to ITW compared to typically developing children. A univalve cast can be fabricated and removed without the use of a cast saw. Traditional serial casting was initiated for a 3-year-old with a history of autism and ITW presenting with ankle dorsiflexion lacking 26 and 30 degrees on the left and right side respectively. Due to behavioral issues, parent removed casts on the first night to prevent significant interruption to child’s sleep. During subsequent appointments, therapists fabricated univalve casts allowing the casts to be worn during the daytime but removed at night.

Outcomes: Using the univalved casting technique, the child demonstrated a gain of over 25 degrees of ankle dorsiflexion in 6 weeks. This increase in range of motion will allow for the use of AFOs to assist with maintaining range of motion and achieving heel strike with ambulation. Due to difficulty with the family attending appointments, no additional follow up visits were completed.

Discussion: Therapists can provide conservative methods of managing ankle dorsiflexion to children with ITW through serial casting. When this is not tolerated a univalve cast that allows removal and reapplication by the caregiver with weekly fabrication for progression should be considered. This method can improve ankle range of motion while providing improved tolerance, participation, and safety.