Serial casting for equinus deformity in children with cerebral palsy: A systematic review

Abstract

Aim: The primary cause of gait deformity in children with cerebral palsy (CP) is equinus foot. Children with equinus foot typically receive physiotherapy as part of their care, as serial casting. In this study, we aimed to systematically examine the impact of serial casting procedure in children with CP with equinus deformity. Material and Methods: Articles were identified from 2008 to 2019 by literature searches using Medline (MEDLINE), physiotherapy evidence base (PEDro), and Cochrane database. Randomized trials focused on CP children with equinus deformity were included. Data were extracted from the included studies and methodological quality of these data was evaluated using the PEDro scale. The modified Sackett scale was used to evaluate the level of evidence of each intervention. Results: Four trials with good quality methodology were identified with good quality methodology. It was examined whether studies regarding intervention techniques were heterogeneous or not. Findings were analyzed in qualitative terms.This review revealed moderate evidence in three articles about the effectiveness of serial casting application and the ineffectiveness in one article, in addition to traditional physiotherapy programs. Meta-analysis was applied for homogeneous studies and it showed that serial casting could be used as a method to improve deformity of the equinus. Discussion: The current systematic review analyzed four randomized controlled trials, applying strict inclusion selection criteria. The present evidence supports the use of serial casting for improving equinus deformity and modulates spasticity in children with CP and it is considered a moderate evidence of the efficacy of serial casting application.Although the findings of this review support the effectiveness of serial casing application in CP children with equinus deformity, additional randomized control trials with a larger sample size are still required to confirm the present evidence.