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:
Many children and young people already see rapid improvement in stages 1 and 2 – we only operate when it’s truly necessary.
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.
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.
for patients from Germany or abroad
Location
Overnight stay
Rental wheelchair
Walking boot
We can usually discharge you after two hours. Follow-up checks are done online again.
(private or public insurance)
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.
Since the 1990s, David Pomarino has been training in physiotherapy, Spiral Dynamics, sensory integration therapy and Bobath therapy in Germany.
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.
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.
David Pomarino has now published multiple books and several dozen technical articles on gait abnormalities in children:
Every child is different, so there’s no general answer to this question. It’s not possible to give an exact time frame before we have examined your child. On average, treatment with our three-step procedure lasts anywhere from 6 to 24 months.
The fundamental rule is: The sooner the better! David Pomarino and his team of experts will examine your child and can then assess whether it makes sense to continue waiting or whether treatment should begin immediately.
If you’re unsure whether there’s something wrong with your child, your first step is usually to see your pediatrician. That is fundamentally the right thing to do. Unfortunately, gait abnormalities in children, including toe walking, are a highly specialized field of expertise. That’s why you’re in good hands at the Pomarino practice.
At the Pomarino practice, your child will receive treatment for toe walking from one source. David Pomarino has experience treating toe walkers that is internationally unparalleled. This ensures that your child is treated using the gentlest methods.
In Germany, the treatment costs – and often the costs for assistive devices as well – are usually covered by public health insurance. For uninsured services and foreign patients, there is a self-pay option.
Appointments can only be made by calling the Pomarino practice offices. Please contact us at +49 40 51 32 08 80.
Since we can also take measurements for assistive devices in our Hamburg office if needed, it’s ideal for the initial appointment to be in Hamburg. However, German patients can also make appointments for special toe walking consultations that David Pomarino holds in cooperation with doctors in various clinics and practices throughout Germany. For self-payers and our international patients, there’s also the option of having an initial assessment via video consultation.
For certain toe walkers, the gait abnormality disappears on its own after some time. However, some require a treatment consisting of multiple steps that often begins with insoles as the mildest form of treatment. Genetic testing helps to assign your child to one of the groups in order to decide whether waiting may be an option – or whether a delay might mean wasting valuable time.
The orthopedic technology department in Hamburg uses the most modern modeling techniques. The techniques range from outline drawings to impact foam molds and 3D body scans. Depending on your needs, we’ll send you the necessary material for taking measurements or a technician will measure your child during an appointment. In some cases, our technician can also come to your home.
The results of the human genetic examination not only make it possible to determine whether a child has inherited a certain predisposition (and potentially can pass it on), but also how this predisposition – in this case, toe walking – should be classified. This allows the appropriate treatment to be selected for each type of toe walker to help your child more quickly. And in the best-case scenario, this can be done without a marathon of diagnostic procedures involving examinations by a pediatrician, orthopedist, neurologist, etc., by X-ray, MRI (under anesthesia), and measuring nerve-conduction velocity.
No. The Pomarino toe-walking test doesn’t require blood. Taking the sample is extremely simple. You’ll receive a sealed sample kit (Oracollect 100) from us, which consists of a cotton swab and an alcohol solution. Use the swab to take a small sample from the oral mucous membrane inside both cheeks and then screw the tube shut with the swab in the alcohol solution. Immediately after closing the tube, shake it for one minute, and it’s ready! Next, send the sample to the practice for analysis in the included return envelope.
It usually takes six to eight weeks after receipt of the sample for it to be analyzed and the results to be determined. Variations are possible depending on the laboratory’s workload. In any case, we’ll inform you immediately as soon as the results are available.
If the result of the human genetic examination is concerning with regard to toe walking, you’ll receive advice on how to proceed along with the results. In such cases, an online consultation in the gait abnormalities practice can often be helpful. If you wish, we can arrange an appointment for a video consultation with David Pomarino, which you can participate in using our video tool certified for medical data transmission.
Once the findings of the human genetic testing are available, they provide indications as to which treatment measures will help reduce toe walking. The test helps to spare the child a diagnostic marathon and to start the appropriate treatment sooner.
Most of our selective percutaneous myofasciotomies can now be performed in our outpatient clinic in Hanover. More complex procedures are performed on an inpatient basis at the DIAKOVERE Annastift clinic in Hanover. We’ll discuss the various options with you in detail beforehand.
Lower-leg walker boots (“MobiWalkers”) must be worn for a period of three weeks. They are put on during the operation or immediately afterwards. The legs need to be checked several times a day for any pressure points.
With lower-leg walker boots, full weight bearing is immediately possible, but may require forearm crutches. When showering/bathing, it’s also possible to bear weight without a walker for a short time.
Ankle-joint movement training, stretching adjusted for pain level, and gait training should be carried out. It should start in the first few days after the operation. During physiotherapy, the walker can be removed.
Lymph drainage should be done in the first 10 days after surgery.
No suture removal is necessary. Wound checks are recommended in case of abnormalities such as redness or swelling.
Immediately after surgery, lower-leg walker boots are worn for about three weeks. This is followed by a transition to lower-leg night splints (only at night) and lower-leg orthotics (for daytime use). The orthotics are needed for about three months, while the night splints are needed for about six months.
Attending school is possible whenever the child is sufficiently mobile. The lower-leg walker boots need to be worn for the first three weeks after the operation.
Your child can start engaging in physical activity again six weeks after the operation.
Pain relievers can be used if necessary.
The Pomarino practice checks the results of surgery.
Occasionally, slight swelling occurs in the surgical area, which can also lead to discomfort on the outer edge of the foot. In this case, lymph drainage is recommended, which can lead to a reduction in these changes.
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.