Effect of serial casting for the prevention of equinus in patients with acute head injury.

Ten adults with traumatic head injury received serial casts within 14 days of injury for the prevention or correction of equinus. Eighteen limbs (16 bilateral) with spasticity were involved. An average of five casts for a total duration of four to 64 days were used for each limb. Comparisons of passive dorsiflexion measures before and after casting showed a mean gain of 21 degrees (paired t-test, P less than .05). Of the 18 limbs, 13 reached a passive dorsiflexion of 0 degrees or more (ie, no equinus) which could be maintained without force for at least one hour. The procedures appeared safe and the results of the trial were clinically judged to be favorable. There is a need to further assess the efficacy of serial casting through randomized controlled trials and long-term followups.