Therapeutic Casting & Splinting of the Lower Extremity - A Manual Therapy Approach: Techniques to Improve Joint Alignment for Function

November 5-6, 2022
9:00 AM - 5:30 PM Saturday & Sunday



$650.00 (Group Discounts Available)

Group Discounts

Groups of 4-6 from the same facility = 5% discount

Groups of 7+ from the same facility = 10% discount

For more information, email

Course Description

This course will provide the knowledge base and practical skills for use of casting materials to manage common impairments in pediatric and neurologic patient populations. Participants will learn to identify appropriate candidates for casting, problem-solve which materials and techniques are appropriate for various clinical presentations, and evaluate progress. The course will emphasize the current evidence related to casting and foot/ankle intervention, the importance of differential diagnosis, and the use of the therapist's manual intervention before and during casting to maximize therapeutic effects of casts. Attendees will learn to align casts optimally for therapeutic gait and standing. The course will include multiple opportunities to learn and apply hands-on practical skills which can be carried over to the clinical setting after course completion. Audience: physical therapists and physical therapist assistants.

Course Objectives

At the conclusion of the course, participants should be able to:

1. Discuss candidate identification for serial casting using the ICF model, including rationale, assessment, considerations, precautions, and contraindications.

2. Contrast various materials used for serial casting and splinting, with their different properties and benefits for use for varied therapeutic goals.

3. Describe a variety of casting techniques that might be employed depending on patient presentation and goals.

4. Demonstrate assessment for lower extremity serial casting, including gait, weightbearing and non-weightbearing alignment, tone, and triplanar, multi-joint ankle and foot mobility.

5. Discuss and perform soft tissue mobility assessment and mobilizations prior to and during cast application.

6. Describe basic concepts of shank kinematics as they relate to cast and orthotic design.

7. Apply a lower extremity serial cast with appropriate alignment of joints and application of casting materials utilizing effective body mechanics.

Course participants will receive a detailed manual with assessment and background information, guide to casting materials, step-by-step instructions, and recommended competency assessment.

About the Instructors

Amanda Hall, PT, MPT, PCS, ATP, received her MPT from the University of Washington in 2001, and she re-certified as a Pediatric Clinical Specialist in 2020. Her clinical practice is at the HSC Pediatric Center in Washington, DC. Amanda also provides continuing education instruction in therapeutic casting, orthotic design, and treatment of the foot and ankle, with a framework based on PNF principles, therapeutic alliance, developmental movement system analysis, neuroplasticity, manual therapy, patient-centered design, and therapeutic gait. Amanda has presented internationally, with special emphasis on serving patients with complex presentations and “outliers”, including at the Combined Sections Meeting of the American Physical Therapy Association, the APTA Pediatrics Annual Conference, and at the National Institutes of Health.


Day 1 (7.25 contact hours)

08:30-09:00 Course Registration & Sign-in/Breakfast
09:00-09:30 Therapeutic Casting Framework based on the ICF Model

  • Overview of casting
  • Review of relevant literature
  • Framework for proposed technique:
  • Addressing drivers and contributing limitations
  • Identifying directional susceptibility to movement and relative stiffness
  • Aligning the hindfoot to allow for dorsiflexion to occur at the talocrural joint
  • Position of patient and therapist for effective and efficient treatment
  • Directed input of cast
  • Segmental application
  • Use of clinical reasoning throughout cast application

09:30-10:00 Ankle and Foot Function

  • Functional state: Multi-joint, triplanar motion, muscular function
  • Structural variants and relevant orthopedic impairments

10:00-10:30 Hindfoot alignment diagnostic groups:

1. Neutral Hindfoot

2. Supinated Hindfoot

3. Pronated Hindfoot

10:30-10:45 Break

10:45-11:45 Lab: Lower extremity casting examination and evaluation

1. Weightbearing examination

2. Non-weight bearing examination

a. Integumentary

b. Bony structure

c. Muscular activity and length

d. Soft tissue extensibility

e. Alignment and joint motion: hindfoot, midfoot, forefoot

f. Talocrural range of motion

g. Dorsiflexion goniometry: establishing intra- and inter-rater reliability

3. Evaluation: Making a plan for pre-casting intervention based on lab findings

11:45-12:30 Lab: Foot and ankle manual intervention to address ankle alignment and dorsiflexion in preparation for casting

a. Techniques to address patient stress, guarding, and tonic muscle contraction

b. Techniques to improve soft tissue mobility

c. Techniques to improve joint alignment and mobility

12:30-01:30 Lunch

01:30-02:45 Lab: Casting techniques, patient in sitting (groups of 2, each partner gets to practice)

1. Circumferential wrapping

2. Selective reinforcement

3. Combination of materials

4. Creating an anchor

5. Use of elastic tension and direction of pull to influence tissue and joint mobilization

6. Creating a heel lock

7. Selective support on one side of distal extremities

8. Forming functional weightbearing position for the forefoot

9. Use of spacers

02:45-03:15 Lecture and demonstration: Casting Materials and Tools

Required tools, Properties of materials, Principles of material selection, Safety considerations

Putting it all together:

1. Integrating examination findings to select appropriate techniques

2. Combining isolated techniques into a cast

03:15-03:45 Demonstration: Application of cast using learned techniques

03:45-04:45 Casting Lab

  • Examination and evaluation
  • Position of patient/casting team
  • Pre-casting treatment
  • Cast plan
  • Cast Application: Demonstration of techniques: direction of pull, varying tension, hindfoot lock, 2 person hindfoot mobilization, selective reinforcement, weightbearing position of forefoot

04:45-05:30 Group Activity: Review of Casts: alignment, function, trouble-shooting and clinical fixes

Day 2 (7.25 contact hours)
08:30-09:00 Course Sign-in/Breakfast

09:00-10:00 Lecture: Introduction to use of therapeutic casts to address gait impairments

1. Discussion of relevant gait kinetics and kinematics

2. Three gait impairment groups associated with limited dorsiflexion:

a) Shank angle WFL (toe walking)

b) Excessively reclined shank (knee hyperextension)

c) Excessively inclined shank (crouch)

3. Cast design strategies to influence gait kinetics and kinematics for each group during loading response, weight acceptance, and terminal stance

10:00-10:30 Small Group Activity: Case study problems, calculating and cutting posts to best impact shank kinetics with regard to sagittal and coronal plane findings

10:30-10:45 Break

10:45-11:30 Lab: Prone techniques lab, “patient” in prone using case study molds

1. Circumferential wrapping

2. Selective reinforcement

3. Combination of materials

5. Creating an anchor

6. Use of elastic tension and direction of pull to influence tissue and joint mobilization

7. Creating a heel lock

8. Selective support on one side of an extremity

9. Forming functional weightbearing position for the forefoot

11:30-12:15 Lab: Aligning casts for therapeutic gait: Using mold and case study, determine angle and cut posting material to align for therapeutic gait

12:15-01:15 Lunch

01:15-02:15 Casting Lab: Case study cast application in prone using molds

  • Position of patient/casting team
  • Description of pre-casting treatment
  • Cast plan
  • Cast application using selected prone techniques from cast plan

02:15-02:30 Group Activity: Review of casts: alignment, function, trouble-shooting, and clinical fixes

02:30-03:00 Demonstration: Putting it all together: advanced casting demonstration, including use of clinical reasoning pathway and aligning for therapeutic gait

03:00-04:15 Lab: Casting lab in sitting

  • Examination and evaluation
  • Position of patient/casting team
  • Pre-casting treatment
  • Cast Plan: Advanced application of clinical pathway
  • Cast Application: demonstration of selected techniques according to cast plan, aligning for therapeutic gait

04:15-04:30 Group Activity: Review of casts: alignment, function, trouble-shooting and clinical fixes

04:30-05:00 Group Activity: Therapeutic exercise to maximize effects of casting

05:00-05:30 Final discussion and questions


Texas Children's Hospital Feigin Center

1st Floor Conference Room A
1102 Bates Street
Houston, TX 77030

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Hotel Accommodations


6750 Main Street, Houston, TX 77030


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Who Should Attend

This course is applicable for OTs, OTAs, PTs, and PTAs


14.5 contact hours or CCU's. This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2303051TX and meets continuing competence requirements for physical therapists and physical therapist assistants licensure renewal in Texas for 14.5 CCU's