To localise support for serial casting treatment for children in Wales as provided by Physiotherapists and Assistant Physiotherapists.

Why do this?

Serial casting has been provided by out-of-county hospitals, making access difficult and involving children and their families travelling long distances.

What is it?

This intervention improves the calf muscle length and walking ability of young people who walk on their toes and have tight calf muscles.


Serial casting is a common treatment for children and young people who walk on their toes and have tight calf muscles. The main aims of serial casting are to improve calf muscle length, improve walking pattern and efficiency and to reduce pain. There is a strong evidence base showing serial casting is an effective treatment.

The Bevan Exemplar Innovation took place in Powys with the provision of this service close to home, instead of out-of-county-hospitals. Betsi Cadwaladr Health Board presents with similar same issues as Powys, and worked through the Adopt and Spread Programme to implement changes that brings the services close to home.


Within 3 months of participation in the national Adopt and Spread Programme, physiotherapists had received initial training for serial casting. Due to COVID-19, there were some delays, but with perseverance, this approach is now accessible with all the pediatric physiotherapists and assistant physiotherapists receiving training, having access to the resources, and are supporting young people in North Wales to receive care locally.