Bilateral Walking Casts – Achilles (Heel Cord) Stretch


E had outgrown her AFO from Dr. Paul Jordan (New York) early in the year.  It’s not that she grows that quickly… it’s just that we got busy with life… and she started complaining when we would put the AFO on.  Taking a closer look, it was apparent that the arch support was no longer in the right spot.

We took some videos and sent them to Dr. Jordan for evaluation.  He replied that E definitely needed a new AFO – it didn’t come up nearly high enough on her calf and wasn’t in the right position on her foot.  Yikes, mommy guilt.

Our dollar is really low right now and another trip to New York was just out of the question for us financially.  So we decided to pursue things locally this time, despite my nervousness to do so.  After all the referrals and consultations were completed…we had ended up going without an AFO (using off-the-shelf Chipmunk UCBL’s instead) for about 6 months.

Don’t try this at home, folks.  Not sure how time slipped by on me so quickly, but it did.  And suffice it to say, going without an AFO when you need one, is not a good thing.  E lost a lot of range in her ankle (passive dorsiflexion), and her foot definitely started to form that c-shape curled inwards again.  Had my neglect destroyed her foot forever?!?!?!

Enter a new PT who saved the day!  The PT suggested a round of serial casting to try to get that dorsiflexion range back in her ankle.  I was interested in following Dr. Paul Jordan’s bilateral walking cast protocol, and the PT was supportive of this.  We had amazing help from the local hospital cast technicians and our new orthotist as well!

E ended up having bilateral walking casts for almost 4 weeks, being changed every 1-1.5 weeks with an increase in stretch each time.  Why bilateral?  To keep the sensory stimuli the same for both feet.  To prevent limping and decreased weight bearing on the right.  We need that good weight bearing to provide the stretch… The PT just mirrored the angle the Rt ankle could achieve and set that same angle on the left.

Here’s the protocol for anyone interested.

Serial below the knee casting is used for correction of mild contractures and muscle shortening of the Achilles group and with some elongation (growth, not stretch) of the hamstrings. Casts are also applied following surgical lengthening of the Achilles. No crutches are needed – in fact, not desired if the purpose is to gain or retain length of the posterior leg muscles.

Did it work?  YES!!!!  E was able to gain about 15 degrees increased range over the 3.5 weeks.  She moved right into her new set of AFOs, to provide support for the newly elongated muscles.


I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.


“Praise be to the God and Father of our Lord Jesus Christ. The Father of compassion, the God of all comfort, who comforts us in all our troubles so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow into our lives, so also should the comfort of Christ overflow.” (2 Corinthians 1:3-5)



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