Serial casting for neuromuscular flatfoot and vertical talus in an adolescent with hereditary spastic paraplegia

PURPOSE: The purpose of this report is to explore assessment and serial casting intervention for painful rigid flatfoot deformities with vertical talus in an adolescent girl with hereditary spastic paraplegia who was nonambulatory. SUMMARY OF KEY POINTS: The participant's right foot underwent 2 phases of casting with correction first toward hindfoot inversion and then dorsiflexion. Because of a vertical talus, her left foot required an intermediate casting toward plantar flexion, inversion, and forefoot adduction prior to casting toward dorsiflexion. STATEMENT OF CONCLUSIONS: The patient improved despite the underlying progressive neuromuscular disorder. Pain ameliorated and she returned to supported standing and transfers. Spasticity decreased bilaterally and the flexibility of her foot deformities improved to allow orthotic fabrication in subtalar neutral. Results were maintained at 12 and 16 months. RECOMMENDATIONS FOR CLINICAL PRACTICE: Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.