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Is your child toe walking? Surgery is NOT the only option!
At the Pomarino practice for gait abnormalities, we treat toe walking in children with the gentlest possible hand.
Don’t worry – complicated surgery isn’t the only treatment!
With more than 20 years of experience, we treat our young patients as gently as possible in 3 steps:
Pomarino pyramid insoles
01
Supplementary night splints and muscle relaxation therapy
02
03
Many children and young people already see rapid improvement in stages 1 and 2 – we only operate when it’s truly necessary.
What our satisfied patients say
As parents, we can only say thank you!!! Our son is so much better ‘on his feet’ than before treatment. And he keeps progressing.
We feel like we’re in good hands. Finally there’s someone who can treat our daughter.
Not only did Mr. Pomarino help our daughter a lot, but he also gave me expert advice and now I know who to turn to with my orthopedic problems.
As parents, we can only say thank you!!! Our son is so much better ‘on his feet’ than before treatment. And he keeps progressing.
We feel like we’re in good hands. Finally there’s someone who can treat our daughter.
Not only did Mr. Pomarino help our daughter a lot, but he also gave me expert advice and now I know who to turn to with my orthopedic problems.
As parents, we can only say thank you!!! Our son is so much better ‘on his feet’ than before treatment. And he keeps progressing.
We feel like we’re in good hands. Finally there’s someone who can treat our daughter.
Not only did Mr. Pomarino help our daughter a lot, but he also gave me expert advice and now I know who to turn to with my orthopedic problems.
Is your child toe walking?
What signs should parents be concerned about?
- If children walk almost exclusively on their tiptoes
- If they can’t put their heel down at all or rolling the foot is painful
- If toe walking doesn’t stop on its own after a few months
What are the consequences of toe walking?
- On a physical level:
- Misalignments and pain in the back, feet, and knees
- Into adulthood
- On a personal level:
- Limited participation in physical education classes or none at all, and even bullying
- This can lead to psychological problems for your child
Why childhood toe walking is often treated incorrectly
- Option 1: Delay treating the problem
- Many doctors take the approach: “They’ll just grow out of it!”
- That may be the case – but not necessarily!
- If they don’t just grow out of it:
- The earlier you bring your child to an expert, the better the chances of successful treatment, even without surgery.
- Option 2: Operate immediately
- For years, complicated surgery was almost always the only treatment option. In many countries and at many medical practices, that’s still what parents hear.
- But lengthening the Achilles tendon doesn’t guarantee a cure.
- Not to mention that children are unable to walk for months after the procedure. As a parent, that’s something you certainly want to avoid.
That’s why you should choose
- Option 3: Assessment by specialists
- David Pomarino refused to accept that such a serious operation was the only option for children, so he spent over 20 years researching childhood toe walking.
- The result was a three-step treatment method:
- As gently as possible
- With rapid success
- Surgery as the last option
David Pomarino’s three steps of treatment
It goes without saying that what comes first is a detailed diagnosis.
At the initial consultation, we examine your child, ask you as parents about the symptoms and how long they’ve existed, and conduct a movement analysis.
There’s also the option of performing genetic testing.
This lets us rule out any underlying neuromuscular diseases as causes for toe walking. You can find more information about that here.
All our treatments begin with step 1 – the gentlest procedure. We recommend methods from step 2 or 3 only if step 1 doesn’t yield the desired improvement.
Step 1: Pomarino pyramid insoles
- We take measurements, and you insert the insoles made specifically for your child into his or her shoes.
- The pyramid-shaped ridges in the insoles help children land their feet primarily on the heel.
Step 2: Night Splints and Muscle Relaxant Injections
- To counteract a pointed or equinus foot position while sleeping, your child will wear custom splints at night.
- If needed, we can support treatment with assistive devices by injecting a muscle relaxant to relax the leg muscles.
Step 3: Minimally invasive surgery
- Step 3: Minimally invasive surgery
- Individual fasciae are scored or severed. Afterwards, the muscles can stretch and the child is able to use a rolling motion over the heel when walking.
- There’s hardly any pain, and your child can walk again the same day.
- In most cases we can help our young patients with these 3 steps. But of course every child is different. If there’s no other option, we can also perform more complex surgery to help your child.
The course of treatment
for patients from Germany or abroad
- On average, treatment lasts about 6 to 24 months
- Of course, every child is different and we approach treatment so that the patient achieves therapeutic results as gently and quickly as possible
- We always review progress thoroughly before recommending the next treatment step
Sample procedure for patients outside Germany
Step 1: Video consultation
- Determining medical history, including gait analysis and genetic testing (if desired)
Step 2: If necessary, on-site appointment in our Hamburg office
- Assessment plus studio appointment if required
Step 3: Treatment at home
- Everything you need to make the assistive devices will be sent to you by mail.
- Online follow-up checks
Location
Overnight stay
Rental wheelchair
Walking boot
We can usually discharge you after two hours. Follow-up checks are done online again.
Sample procedure for patients from Germany
(private or public insurance)
Step 1: Appointment for consultation
- In our practice in Hamburg or one of David Pomarino’s special consultations nationwide
- Determining medical history, including gait analysis and genetic testing (if desired)
- Assessment plus studio appointment if required
Step 2: Follow-up treatment
- Follow-up checks and the prescription of any additional treatment methods are done in our practice in Hamburg or online. If applicable, you can also visit one of our partner practices or clinics in your area.
We offer our consultations throughout Germany – including in your area:
How can I make an appointment?
Simply click on the “Make an appointment today” button. We’ll give you a call: there’s no commitment on your part. Together, we’ll make an appointment for a consultation.
About David Pomarino
The beginning:
Since the 1990s, David Pomarino has been training in physiotherapy, Spiral Dynamics, sensory integration therapy and Bobath therapy in Germany.
His specialty
He gained international recognition through his interdisciplinary research and publications on the diagnosis, classification, and treatment of childhood toe walking.
As part of his research, he developed an insole with stepped ridges (“pyramids”), which is known today as the “Pomarino insole.”
Since 2002, David Pomarino has operated his own practice in Hamburg to treat children with gait abnormalities.
Awards
For his research, David Pomarino was awarded an honorary doctorate as an “Illustre Amigo” by the Bolivian medical association “Colegio medico de La Paz”. His volunteer work for children’s welfare led to his appointment as ambassador for the children’s charity UNICEF for Bolivia.
Publications:
David Pomarino has now published multiple books and several dozen technical articles on gait abnormalities in children:
Frequently asked questions
Frequently asked questions about genetic testing
Frequently asked questions about surgery
The Pomarino Practice for Gait Abnormalities in Hamburg
Our practice is centrally located in Hamburg-Harvestehude. Here we examine our young patients from Germany and abroad.
You can also bring your child to a special consultation in one of our cooperating clinics or practices throughout Germany. You can see their locations here.
