Treatment of rare orthopedic and neurological diseases

•  Description of the disease

  Polymicrogyria is a rare brain malformation characterized by the presence of numerous, small and abnormally shaped corners of the cerebral cortex. The condition results from an abnormal process of neuronal migration during prenatal brain development. Symptoms of polymicrogyria can be varied and include psychomotor developmental delay, speech disorders, motor coordination problems, epilepsy and limb paralysis. The severity of symptoms depends on the location and extent of the brain lesions

• Diagnostics

  The mainstay of the diagnosis of polymicrogyria is brain imaging with magnetic resonance imaging (MRI), which reveals the characteristic image of multiple, tiny corners of the cerebral cortex. Sometimes additional tests such as EEG (electroencephalography) can be helpful to assess the bioelectrical function of the brain, especially in patients with epilepsy. A detailed clinical history and neurological examination are also important to assess the degree of neurological deficits.

• Our approach to treatment

  In our approach to treating patients with polymicrogyria, a multispecialty approach focused on the individual needs of the patient is paramount. A key component of therapy is to control symptoms, especially epileptic seizures, and to improve quality of life through intensive neurological rehabilitation, speech and psychological therapy. The priority is to make the patient as comfortable as possible, both physically and mentally.

• Treatment Methods

  Treatment of polymicrogyria is mainly symptomatic, as there is no way to completely remove the structural abnormalities of the brain. Pharmacological treatment focuses on controlling epileptic seizures with antiepileptic drugs. In selected cases, when pharmacological treatment is ineffective, surgical treatment (such as resection of epileptogenic foci) may be considered. At the same time, intensive physical rehabilitation, occupational therapy, speech therapy and psychological support are used to improve the patient's functioning.

•  Post-operative care

  Intensive and regular postoperative care, including neurological monitoring, monitoring of seizure function and rehabilitation tailored individually to the patient's abilities and needs, is important for patients who have undergone surgical treatment. After surgery, systematic neurological, speech and occupational rehabilitation is also recommended, which significantly affect the final results of treatment and improve the patient's quality of life.

• Treatment results

  The results of treating patients with polymicrogyria are varied and depend on the degree and location of the lesions, as well as the effectiveness of the therapeutic methods implemented. Although the brain's structural changes remain permanent, appropriately selected therapy can significantly reduce neurological symptoms, reduce the frequency of epileptic seizures and improve patients' overall quality of life. Early therapeutic intervention and comprehensive care are crucial for satisfactory treatment results.

• Description of the disease
  

  Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of inherited neurodegenerative diseases whose main feature is progressive spastic weakness of the lower extremities. The disease can present in a pure form (symptoms limited to the lower extremities) or a complex form (with additional neurological symptoms such as ataxia, tremor, epilepsy, mentalretardation).Inheritance can be autosomal dominant, recessive or X-chromosome coupled. The onset of symptoms can occur in childhood, adolescence or adulthood, and the course is chronic and gradually progressive.

•  Diagnostics
  

  The diagnosis of HSP is based on:
  - A thorough family history - the disease often runs in multiple generations.
  - Neurological examination - increased muscle tone (spasticity), muscle weakness in the lower extremities, vivid tendon reflexes, Babinski sign.
  - MRI imaging - in pure form usually without changes, but in complex types, atrophy of the brain or medulla may be visible.
  - Genetic testing - identification of mutations in genes associated with HSP (most commonly SPAST, ATL1, REEP1).

• Our approach to treatment
  

  At our center, we take a comprehensive and interdisciplinary approach to treating HSP, combining the care of a pediatric neurologist, orthopedist, neurophysiotherapist, psychologist and orthotic specialists. It is crucial that these specialists work closely together in one place at one time, ensuring consistent diagnosis and therapy.

• Treatment methods
  

  Treatment of HSP is symptomatic and aimed at improving the patient's quality of life:
  - Pharmacotherapy: drugs to reduce spasticity (e.g., baclofen, tizanidine), sometimes botulinum toxin.
  - Physiotherapy and rehabilitation: intensive, individually tailored improvement program, including verticalization, stretching and strengthening exercises.
  - Orthopedic equipment: orthoses, walkers, wheelchairs to aid mobility.
  - Orthopedic surgery: in cases of significant contractures or deformities - muscle, bone or selective rhizotomy surgery.

•  Post-operative care
  

  After surgical procedures, the key is:
  - Intensive rehabilitation - from the first days after surgery.
  - Control of spasticity and prevention of recurrence of deformities.
  - Evaluation and fitting of orthoses or assistive equipment.
  - Psychological support - especially for children and their families.

• Treatment results
  

  Although HSP remains a progressive disease, with early intervention, appropriate physiotherapy and surgical treatment, it is possible to significantly increase a patient's independence, improve gait patterns, reduce pain and improve quality of life. Many patients succeed in delaying the progression of the disease and avoiding the need for a wheelchair for many years.

• Description of the disease
  

  Aicardi-Goutières Syndrome (AGS) is a rare, genetically determined neuroinflammatory disease that usually manifests in infancy or early childhood. The condition mimics the symptoms of congenital infection, although it is unrelated to viral infection. AGS leads to chronic inflammation within the central nervous system, resulting in developmental delay, spasticity, epileptic seizures and progressive orthopedic deformities - especially in the limbs.

• Diagnostics
  

  The diagnosis of AGS is based on:
  - A detailed family and clinical history,
  - Brain imaging (MRI), where intracranial calcifications, leukodystrophy and cortical atrophy are evident,
  - Laboratory tests (elevated levels of interferon alpha in cerebrospinal fluid),
  - Genetic testing - identification of mutations in AGS-related genes (most commonly TREX1, RNASEH2A, RNASEH2B, IFIH1 and others).

• Our approach to treatment
  

  At Paley European Institute, we focus on an interdisciplinary approach - a collaboration of neurologists, orthopedists, physical therapists and occupational therapists. We focus on promoting a child's motor development, preventing contractures and treating secondary musculoskeletal deformities resulting from spasticity and immobilization.

• Treatment Methods
  

  - Pharmacological treatment: Immunosuppression (e.g., steroids, JAK inhibitors), epilepsy treatment, symptomatic treatment,
  - Orthopedics: Treatment of contractures (e.g., tendon lengthening, corrective osteotomies), including multilevel surgery in children (e.g., SEMLS),
  - Rehabilitation: Intensive physiotherapy, uprighting, functional exercises using orthoses,
  - Nutritional and neurological support.

•  Post-operative care
  

  After orthopedic procedures, we conduct a personalized rehabilitation program tailored to the patient's level of functioning. Our team monitors motor development, ranges of motion, muscle tone and implements supportive therapies - including hydrotherapy, occupational therapy and neuromotor physiotherapy.

• Treatment results
  

  Although AGS is a progressive and incurable disease, early intervention and coordinated care can significantly improve quality of life, reduce the development of deformities and increase a child's independence. Our experience shows that children with AGS can make significant functional progress with appropriately selected orthopedic and rehabilitation therapy.

Musculoskeletal dysplasias are a group of congenital developmental disorders of the skeletal system that affect the growth and development of bones, cartilage and other connective tissues. These conditions are characterized by abnormal bone growth and development, which can lead to a variety of skeletal deformities and growth disorders.

The main features of musculoskeletal dysplasia include:

• Disproportionate growth of different parts of the body
• Abnormalities in the development of long bones
• Abnormalities in the structure of the spine
• Joint problems

Dysplasias can vary significantly in terms of severity of symptoms - from mild forms to severe cases requiring complex treatment. Early diagnosis and appropriate treatment are key to ensuring patients have the best possible quality of life.

Achondroplasia

• Description of the disease

  Achondroplasia is the most common genetically determined form of dwarfism. The condition is caused by a mutation of the FGFR3 gene, responsible for bone and cartilage development. It is mainly characterized by shortened limbs with a normal torso length and an enlarged head with a characteristic forehead. People with achondroplasia often also have other orthopedic changes, such as a deepened lumbar lordosis, valgus knees and spinal defects.

• Diagnostics

  Diagnosis of achondroplasia is based mainly on the patient's clinical picture and imaging studies, such as X-rays of the limbs and spine. In addition, genetic tests detecting mutation of the FGFR3 gene are performed to confirm the diagnosis. Prenatal diagnosis is possible with ultrasound and genetic tests using amniotic fluid.

• Our approach to treatment

  We take a comprehensive approach to treating patients with achondroplasia, taking into account both orthopedic and general medical aspects. Our priority is to improve patients' quality of life through early diagnosis, interdisciplinary care, and symptomatic and preventive treatment aimed at preventing complications such as spinal defects and limb deformities.

• Treatment methods

  Treatment of achondroplasia is mainly symptomatic and surgical. In cases of significant shortening of the limbs, it is possible to surgically lengthen the bones of the lower and upper limbs, which involves gradual stretching of the bones using special orthopedic apparatuses (Ilizarov method). We also use surgical treatment for significant limb deformities, spinal defects, narrowing of the spinal canal, or instability of the cervical spine.

• Post-operative care

  After surgical procedures, patients require specialized rehabilitation care. Early initiation of physiotherapy is key to achieving good treatment results. Therapy includes exercises to strengthen muscles, increase the range of motion in joints, manual therapy and gait training. Patients remain under the care of an orthopedic surgeon, a neurologist and a physiotherapist, so that any complications can be detected quickly.

• Treatment results

  The results of achondroplasia treatment depend on the severity of the symptoms and the age of the patient at which therapy was initiated. With a comprehensive approach to treatment, it is possible to significantly increase limb growth, improve motor function and quality of life for patients. Surgical treatment and properly selected rehabilitation allow patients to lead independent, active lives and minimize the risk of complications later in life.

Pseudoachondroplasia

• Description of the disease

  Pseudoachondroplasia is a genetically determined skeletal disease that belongs to the skeletal dysplasia group, characterized by short stature with disproportionately short limbs. The disease is the result of a mutation in the COMP gene, which encodes a protein essential for normal cartilage development. Symptoms are usually not apparent shortly after birth, but reveal themselves gradually, usually between the first and third years of life. Characteristics include abnormal growth of long bones, limb deformities, excessive joint mobility and early development of osteoarthritis, especially of the hip and knee.

• Diagnostics

  Diagnosis of pseudoachondroplasia is based on a thorough family history, clinical evaluation of the patient and characteristic radiographic findings. The primary examination is an X-ray, which reveals shortened and deformed long bones, irregular bone epiphyses and developmental abnormalities in the spine. Confirmation of the diagnosis is also possible with genetic testing, which involves detecting mutations in the COMP gene.

• Our approach to treatment

  Our primary goal in treating pseudoachondroplasia is to improve patients' quality of life by minimizing pain, improving motor function and correcting limb deformities. We use an individualized therapeutic approach, taking into account the age of the patient, the stage of the disease and the specific needs of each patient. Priority is given to interdisciplinary cooperation, including an orthopedist, geneticist, physical therapist and psychologist.

• Treatment methods

  Treatment of pseudoachondroplasia is mainly symptomatic and surgical. Initially, we use intensive rehabilitation to strengthen muscles, improve joint mobility and prevent contractures. In cases of severe deformity or significant pain, we use surgical treatment. The most commonly used surgical procedures are corrective osteotomies of the lower extremities, limb lengthening using the Ilizarov or Precice method, and reconstructive procedures of the hip and knee joints.

• Post-operative care

  After surgical treatment, post-operative care is particularly important, which includes appropriate pain management, prophylactic antibiotic therapy and, above all, intensive rehabilitation. We work closely with physiotherapists so that the patient quickly regains mobility. Regular orthopedic and radiological follow-up is also an important part of care, allowing us to assess the healing process and correction of deformities. Patients remain under our constant care throughout the recovery period.

• Treatment results

  With properly selected treatment, patients with pseudoachondroplasia can achieve a significant improvement in quality of life. Corrective surgeries make it possible to significantly improve limb function, increasing mobility and reducing pain associated with progressive osteoarthritis. Regular rehabilitation and systematic care allow long-term maintenance of favorable treatment results, enabling patients to lead active social and professional lives.

Hypachnodroplasia

• Description of the disease

  Hypoachondroplasia is a genetically determined disease of the bone dysplasia group, characterized by abnormal growth of long bones and proportional shortening of limbs. The disease resembles achondroplasia, but its symptoms are milder and patients reach a higher height. The most common cause of hypoachondroplasia is mutation of the FGFR3 gene, responsible for normal bone growth and development.

• Diagnostics

  Diagnosis of hypoachondroplasia is based on a detailed clinical analysis, family history and radiological studies. X-rays are taken, which show characteristic changes such as shortening of the long bones, especially the femurs and humerus. It is also helpful to perform genetic testing with mutation analysis of the FGFR3 gene to confirm the diagnosis.

• Our approach to treatment

  In treating patients with hypoachondroplasia, the priority is to improve quality of life, reduce pain and optimize musculoskeletal function. We focus on an individual approach to the patient, taking into account the degree of severity of the deformity and the patient's personal expectations and needs. Comprehensive care from a team of specialists, including an orthopedist, physical therapist, endocrinologist and psychologist, is key to successful treatment.

• Treatment methods

  Treatment of hypoachondroplasia primarily involves conservative methods such as rehabilitation and physiotherapy to improve motor function and relieve muscle tension. In some cases, when limb deformities cause significant functional or aesthetic limitations, we use surgical lengthening of the bones using modern methods of distraction osteogenesis (such as the Ilizarov method or external or internal telescopic nailing systems).

• Post-operative care

  After bone lengthening surgeries, we provide carefully selected rehabilitation, including exercises to improve joint mobility, muscle strengthening and pain management therapy. Regular follow-up visits and radiological examinations make it possible to monitor the bone regeneration process and detect possible complications early.

• Treatment results

  With a comprehensive approach, the treatment of hypoachondroplasia makes it possible to significantly improve patients' quality of life. Surgical treatment, especially limb lengthening methods, achieve satisfactory results both aesthetically and functionally. Patients usually experience a marked improvement in their daily functioning comfort and higher self-esteem after treatment.

Vertebrobasilar Dysplasia

• Description of the disease

  Multiple Epiphyseal Dysplasia (MED) is a genetically determined orthopedic disorder characterized by abnormalities in the development of the epiphyseal cartilage, leading to abnormal formation of long bones and joints. The disease most commonly affects the hips, knees, ankles and shoulder joints, leading to pain, limited joint mobility and osteoarticular deformities. Symptoms usually manifest in childhood, with the onset of the child's physical activity.

• Diagnostics

  The diagnosis of MED is based mainly on clinical and imaging examination. A typical picture of the disease can be found on x-rays (X-rays), where characteristic changes including flattening and fragmentation of the epiphyses of long bones can be seen. In addition, magnetic resonance imaging (MRI) is used, which allows precise evaluation of changes in articular cartilage and bone epiphyses. Genetic testing is also an important part of the diagnosis, allowing the identification of specific mutations responsible for the disease.

• Our approach to treatment

  Our approach is based on a comprehensive approach to the patient, focusing on both symptom relief and long-term improvement of musculoskeletal function. Our priority is to improve quality of life through an individually tailored treatment plan that takes into account the patient's age, disease severity, physical activity and specific joint disorders. We work multidisciplinarily with physiotherapists, geneticists and rehabilitation specialists.

• Treatment methods

  Treatment of MED includes both conservative and surgical methods. Conservative treatment focuses on physiotherapy, pain medication and periodic joint relief with orthoses or stabilizers. In cases where deformities are significant, causing severe pain or severe mobility limitations, surgical treatment may be necessary. Surgical treatments include corrective osteotomies, joint surface reconstruction and, in later stages of the disease, joint prosthetics.

• Post-operative care

  Postoperative care for MED patients plays a key role in achieving optimal treatment results. The patient receives intensive rehabilitation aimed at restoring full function of the operated joint, improving range of motion and strengthening muscles. The postoperative period requires regular orthopedic checks and diagnostic imaging to monitor the progress of treatment and possible early detection of complications.

• Treatment results

  The results of treatment of polyarthritis dysplasia are usually favorable, provided there is timely diagnosis and comprehensive treatment including both rehabilitation and surgical treatment when warranted. Most patients achieve significant improvements in quality of life, reduced pain, improved joint mobility and the ability to carry out normal daily activities. Long-term results are particularly good with systematic patient cooperation with specialists and physiotherapists.

Multiple Bone Dysplasia

• Description of the disease

  Multiple Epiphyseal Dysplasia (MED) is a genetically determined orthopedic disorder characterized by abnormalities in the development of the epiphyseal cartilage, leading to abnormal formation of long bones and joints. The disease most commonly affects the hips, knees, ankles and shoulder joints, leading to pain, limited joint mobility and osteoarticular deformities. Symptoms usually manifest in childhood, with the onset of the child's physical activity.

• Diagnostics

  The diagnosis of MED is based mainly on clinical and imaging examination. A typical picture of the disease can be found on x-rays (X-rays), where characteristic changes including flattening and fragmentation of the epiphyses of long bones can be seen. In addition, magnetic resonance imaging (MRI) is used, which allows precise evaluation of changes in articular cartilage and bone epiphyses. Genetic testing is also an important part of the diagnosis, allowing the identification of specific mutations responsible for the disease.

• Our approach to treatment

  Our approach is based on a comprehensive approach to the patient, focusing on both symptom relief and long-term improvement of musculoskeletal function. Our priority is to improve quality of life through an individually tailored treatment plan that takes into account the patient's age, disease severity, physical activity and specific joint disorders. We work multidisciplinarily with physiotherapists, geneticists and rehabilitation specialists.

• Treatment methods

  Treatment of MED includes both conservative and surgical methods. Conservative treatment focuses on physiotherapy, pain medication and periodic joint relief with orthoses or stabilizers. In cases where deformities are significant, causing severe pain or severe mobility limitations, surgical treatment may be necessary. Surgical treatments include corrective osteotomies, joint surface reconstruction and, in later stages of the disease, joint prosthetics.

• Post-operative care

  Postoperative care for MED patients plays a key role in achieving optimal treatment results. The patient receives intensive rehabilitation aimed at restoring full function of the operated joint, improving range of motion and strengthening muscles. The postoperative period requires regular orthopedic checks and diagnostic imaging to monitor the progress of treatment and possible early detection of complications.

• Treatment results

  The results of treatment of polyarthritis dysplasia are usually favorable, provided there is timely diagnosis and comprehensive treatment including both rehabilitation and surgical treatment when warranted. Most patients achieve significant improvements in quality of life, reduced pain, improved joint mobility and the ability to carry out normal daily activities. Long-term results are particularly good with systematic patient cooperation with specialists and physiotherapists.

Stickler syndrome

• Description of the disease
  Stickler syndrome is a rare, inherited connective tissue disease that affects the development of bones, joints, eyes, ears and sometimes the nervous system. It is caused by mutations in the genes responsible for the production of type II, IX or XI collagen, which is an essential component of cartilage and other connective tissue structures. The disease can vary in severity and course, even within a single family.

• Diagnostics

  The diagnosis is based on:
  - A detailed family history
  - Clinical examination (evaluation of joints, face, hearing and vision)
  - Imaging studies - X-ray and MRI to evaluate degenerative changes
  - Ophthalmological and audiological examinations
  - Genetic tests that can confirm mutations in COL2A1, COL11A1, COL11A2 and other genes
  

• Our approach to treatmentInPEI, we focus on integrated multi-specialty care that combines pediatric orthopedics, neurology, genetics, ophthalmology and audiology. Our goal is early diagnosis and prevention of complications, as well as family support throughout the treatment process.

• Treatment methods

  Because Stickler Syndrome is a genetic disorder, treatment is mainly symptomatic:
  - Orthopedic treatment - including correction of limb deformities and treatment of degenerative changes
  - Rehabilitation - improving range of motion and muscle strength
  - Ophthalmic treatments - such as laser therapy to prevent retinal detachment
  - Hearing aids for hearing loss
  - Surgical treatment of cleft palate

• Post-operative care

  After orthopedic procedures, patients undergo intensive motor rehabilitation at our Neurocenter, with an emphasis on maintaining mobility and preventing the recurrence of deformities. Regular ophthalmological and audiological follow-up is an integral part of care.

•  Treatment results

  With well-managed treatment and monitoring, patients with Stickler Syndrome can lead active lives. Early intervention can prevent ophthalmic and orthopedic complications, and comprehensive care from the PEI team significantly improves quality of life.

Diastrophic Dysplasia

• Description of the disease

  Diastrophic dysplasia (DTD) is a rare, inherited genetic disease of the bone dysplasia group, caused by a mutation in the SLC26A2 gene. The condition leads to abnormal cartilage and bone development, especially in the limbs and spine. It is characterized by short stature, shortening of long bones, joint deformities and the presence of the so-called clubfoot. There is also often a contracture of the thumb in the "butonier" position and auricular deformities. Children with diastrophic dysplasia may have difficulty with mobility and require specialized orthopedic care from birth.

• Diagnostics

  Diagnosis is based on characteristic clinical features, imaging studies and genetic testing. Prenatal ultrasound can show shortened long bones as early as fetal life. After birth, X-rays are performed showing shortened and thickened bones, joint deformities and changes in the spine. Final confirmation of the diagnosis is provided by genetic analysis detecting a mutation in the SLC26A2 gene.

• Our approach to treatment

  At Paley European Institute, we offer comprehensive multispecialty care - orthopedic, neurological and rehabilitation - led by a team of experienced specialists. For children with DTD, early implementation of therapy to maximize functional potential and prevent secondary deformities is crucial. Our approach combines the latest surgical techniques with intensive physical therapy and continuous monitoring of the child's development.

• Treatment methods

  Treatment includes:
  - Operative correction of limb deformities - such as straightening knees, removing contractures, lengthening bones.
  - Orthopedic treatment of clubfoot - by the Ponseti method or surgically.
  - Limb lengthening by the PRECICE method or with external braces - in patients with pronounced limb length deficiency.
  - Stabilization and correction of the spine - in the presence of scoliosis or kyphosis.
  - Orthopedic supplies and rehabilitation - individually tailored orthoses and intensive physiotherapy.

• Post-operative care

  After each stage of treatment, patients receive close care from the therapy team. Rehabilitation includes exercises to improve range of motion, muscle strengthening, and learning the correct gait pattern. Regular radiological and clinical checks allow us to assess the effects of treatment and prevent complications. We also adjust orthotic supplies according to the child's stage of development.

•  Treatment results

  Early intervention and treatment provided in an integrated care model allows many patients with diastrophic dysplasia to achieve a high degree of independent mobility. Although the height of children with DTD will always be below normal, appropriate medical management can significantly improve quality of life, mobility and the ability to participate in daily activities.

Morquio team

• Description of the disease

  Morquio syndrome (mucopolysaccharidosis type IV, MPS IV) is a rare, genetic metabolic disease that belongs to the group of lysosomal storage diseases. It is caused by a deficiency of enzymes responsible for breaking down mucopolysaccharides (glycosaminoglycans), leading to their accumulation in tissues and organs. The disease is inherited autosomal recessively and leads to abnormalities in the structure and function of the osteoarticular system and other organs.
  The most common symptoms include short stature, skeletal deformities, joint instability, shortened trunk, thickened facial features and difficulty with movement. Intelligence usually remains normal.

• Diagnostics

  The diagnosis is based on the clinical picture, radiological studies and enzymatic analysis - determination of the activity of the enzymes galactosamine-6-sulfatase (type A) or beta-galactosidase (type B) in leukocytes or fibroblasts.
  Molecular diagnostics can confirm mutations in the GALNS or GLB1 gene.
  Other mucopolysaccharidoses and congenital bone dysplasias should be considered in the differential diagnosis.

• Our approach to treatment

  At our center, we focus on a comprehensive and interdisciplinary approach to the patient with Morquio Syndrome, combining orthopedic, neurological, rehabilitative and metabolic care. We analyze each case individually, planning treatment tailored to the severity of the lesions and the patient's needs.
  We constantly collaborate with a team of geneticists, pulmonologists, cardiologists and anesthesiologists to ensure the safety of treatments and therapies.

•  Treatment methods

  Treatment is mainly symptomatic and supportive:
  - Orthopedic treatment of deformities (scoliosis, knee valgus, cervical spine instability).
  - Surgical procedures, including spinal stabilization, lower limb corrections, bone lengthening
  - Physiotherapy - maintaining mobility, improving muscle strength and flexibility
  - Enzyme pharmacotherapy - substitution therapy (elosulfase alfa) available in some cases
  - Pulmonary and cardiac support - monitoring and treatment of respiratory and cardiac complications

•  Post-operative care

  After each surgical intervention, we provide intensive physiotherapy and monitor respiratory and cardiovascular functions. Our therapy team works closely with the child's family and caregivers to promote a return to activity and the best possible functional development.
  Regular follow-up visits allow early detection of new complications and planning of further treatment steps.

• Treatment results

  Early diagnosis and properly planned surgical and conservative treatment make it possible to significantly improve the quality of life of patients with Morquio Syndrome.
  Although the disease is progressive, with a multidisciplinary approach we are able to effectively slow the development of the deformity and enable patients to maintain their independent mobility for as long as possible.

Ellis-van Creveld syndrome

• Description of the disease

  Ellis-van Creveld syndrome (EVC), also known as chondrectodermal dysplasia, is a rare, genetically determined disease that belongs to the bone dysplasia group. It is inherited autosomal recessively and most often occurs in children from genetically closed populations, such as some Amish groups. The condition affects bone and soft tissue development, leading to characteristic symptoms:
  - Low stature
  - Polydactyly (extra fingers, usually on the ulnar side of the hand)
  - Chest abnormalities (shortened ribs, narrowed chest)
  - Heart defects (in more than 50% of patients, mainly atrial and interventricular septa)
  - Dysplasia of the nails and teeth

• Diagnostics

  Diagnosis is based on:
  - Family history and observation of physical symptoms
  - Genetic testing, identifying mutations in the EVC or EVC2 genes
  - X-ray and skeletal imaging, highlighting shortened long bones and skeletal anomalies
  - Cardiac echo, assessing the presence of congenital abnormalities
  - Genetic and orthopedic consultation

• Our approach to treatment

  At Paley European, we take a comprehensive and multi-specialty approach that includes the collaboration of orthopedists, cardiologists, geneticists and physical therapists. Each patient has an individualized treatment plan tailored to their symptoms and needs. We pay special attention to orthopedic care and improving musculoskeletal function from an early age.

• Treatment methods

  - Orthopedic treatment: correction of limb deformities, treatment of limb length inequalities, sometimes limb lengthening
  - Heart surgery, if significant defects are present
  - Physiotherapy and rehabilitation - to improve mobility
  - Dental specialty care - due to dental developmental disorders
  - Psychological support and family education

• Post-operative care

  After orthopedic procedures, we provide intensive motor rehabilitation. Children remain under the constant control of the therapeutic team, which monitors not only the healing process, but also functional development. Heart defects and other accompanying problems are also regularly monitored and treated in cooperation with other centers.

• Treatment results

  Early diagnosis and a multidisciplinary approach make it possible to significantly reduce the effects of the disease. In many children, it is possible to achieve good mobility and function in daily life. In the case of concomitant heart defects, the prognosis depends on their severity and the effectiveness of cardiac treatment.

Cartilaginous outgrowths are benign developmental changes of bones that occur during growth. They are characterized by the presence of cartilage-covered bone outgrowths, which can occur singly or in multiple locations.

The most common types of cartilaginous outgrowths are:

• Multiple cartilage and bone outgrowths (MHE): An inherited disorder characterized by multiple outgrowths on the long bones, ribs and pelvis. It can lead to bone deformities and growth disorders.
• Ollier's disease (enchondromatosis): A rare disease characterized by the presence of multiple enchondromas (benign cartilage tumors) inside bones. It can lead to deformities and inequalities in limb length.
• Maffucci syndrome: A very rare condition that combines features of Ollier's disease with the presence of hemangiomas. Requires special attention due to the increased risk of malignant transformation.

Ollier's disease

Ollier's disease, otherwise known as enchondromatosis, is a rare congenital disease characterized by multiple benign cartilaginous tumors (enchondromas) that develop inside the bones. The lesions are most often localized in the long bones of the upper and lower extremities, especially in the hand, foot, and femur and tibia. Ollier's disease usually manifests asymmetry of the limbs, their deformities, growth abnormalities and an increased risk of pathological fractures. There is a small risk of malignant transformation of enchondromas into chondrosarcomas.

• Diagnostics

  The primary diagnostic tool for Ollier's disease is radiography (X-ray), which shows characteristic changes within the bone, such as irregular, well-demarcated foci of translucent cartilaginous structures. In addition, imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) are performed to assess the extent of the lesions and their impact on surrounding tissues. If malignant transformation is suspected, a tumor biopsy and histopathological examination may be necessary

• Our approach to treatment

  We use a multispecialty and individualized approach to treat Ollier's disease. The main goal of therapy is to improve the patient's quality of life by reducing pain, correcting limb deformities and preventing possible complications such as pathological fractures and malignant transformation. The treatment plan is tailored to the patient's age, location and extent of the lesions.

• Treatment methods

  Treatment of Ollier's disease most often involves surgical methods. We use procedures such as removal or curettage of the enchondromas with simultaneous replacement of the defect with a bone graft or bone substitute. In cases of significant deformity and shortening of limbs, we perform reconstructive surgery, corrective osteotomies and limb lengthening procedures using Ilizarov apparatus or internal lengthening nails. In rare cases of malignant transformation, oncological treatment with tumor resection and complementary therapy is necessary.

• Post-operative care

  After surgical treatment, the patient requires intensive rehabilitation aimed at restoring limb function, improving range of motion and strengthening muscles. Depending on the treatment method used, the patient may require temporary immobilization of the limb, the use of crutches or stabilizing orthoses. We perform regular follow-up imaging examinations to monitor the bone healing process and detect any recurrence or complications early.

• Treatment results

  Treatment results for Ollier's disease are usually good, especially in cases diagnosed early and treated appropriately. Surgical procedures can effectively reduce pain, correct deformities and minimize the risk of pathological fractures. In cases where limb lengthening is used, significant improvements in limb function and symmetry can be achieved. It is worth noting that regular medical check-ups and properly conducted rehabilitation have a significant impact on maintaining good treatment results.

MHE (Multiple Hereditary Chondrosarcoma).

•  Description of the disease

  Multiple Hereditary Exostoses (MHE) is an inherited skeletal disorder characterized by the presence of multiple cartilaginous outgrowths, also known as osteochondromas. These outgrowths most often develop near the epiphyses of long bones, such as the femur, tibia, humerus and forearms. MHE is caused by mutations in the EXT1 or EXT2 genes and is inherited in an autosomal dominant manner. The disease can lead to limb deformities, growth abnormalities, pain and reduced joint mobility. The risk of osteochondroma malignant to chondrosarcoma is low, but requires constant observation.

• Diagnostics

  Diagnosis of multiple cartilaginous outgrowths is based primarily on clinical examination of the patient and imaging studies. The basis of diagnosis is an X-ray, which shows the typical lesions of the disease: multiple outgrowths with a characteristic cartilage "cap." In case of diagnostic doubt, more detailed methods such as computed tomography (CT) or magnetic resonance imaging (MRI) are also used. Special attention is paid to assessing the thickness of the cartilaginous cap, as an increase in its thickness may suggest a neoplastic process.

•  Our approach to treatment

  In treating MHE, we take an individualized approach, taking into account the age of the patient, the location of the lesions and the severity of the disease. The priority is to reduce pain, improve motor function and prevent possible complications, such as joint deformities or malignancy of lesions. We always work closely with the patient and his family, establishing treatment goals and developing an individualized therapeutic plan.

• Treatment Methods

  The primary method of treating MHE is surgical removal of cartilaginous outgrowths that cause pain, reduced function or limb deformity. The surgical procedure involves complete resection of the lesion along with the cartilage cap covering it, with care taken to preserve healthy bone and joint structures. In cases of large bone deformities, we perform limb axis corrections and use alignment osteotomies. In less advanced situations, treatment can be conservative, consisting of regular clinical and imaging checks and rehabilitation to improve joint function.

• Post-operative care

  After surgery, the patient receives comprehensive rehabilitation care, including physiotherapy and manual therapy to restore limb function, reduce pain and improve comfort. Post-operative follow-ups take place regularly, including imaging studies to assess the effectiveness of the surgery and to monitor any recurrence of the growths. Patients receive individualized recommendations for limb weight-bearing, physical activity and further management of daily life.

• Treatment results

  The results of treatment of multiple cartilaginous outgrowths are favorable in most patients, especially when surgical treatment is implemented early enough. Surgical removal of painful lesions significantly improves quality of life, limb function and reduces the risk of deformity. In most patients, we achieve a long-term reduction in pain symptoms and an improvement in quality of life. Constant observation allows early detection and treatment of possible complications, which significantly affects the effectiveness of long-term management.

Maffucci syndrome

• Description of the disease

  Maffucci syndrome is a very rare, non-hereditary disease characterized by multiple intramedullary cartilaginous tumors (enchondromas) coexisting with vascular lesions, most often cavernous hemangiomas of the skin or soft tissues. The disease usually appears in early childhood, and the typical symptom is deformity and asymmetry of the limbs, associated with multiple bony tumors and vascular lesions. There is a risk of malignant transformation of chondrosarcomas into chondrosarcoma.

• Diagnostics

  The diagnosis of Maffucci syndrome is based primarily on clinical evaluation and imaging studies. Radiological examinations (X-ray, CT and MRI) reveal numerous intramedullary cartilage-like lesions and bony deformities. In addition, magnetic resonance imaging (MRI) allows accurate assessment of vascular changes and the extent of soft tissue lesions. Biopsy of bone lesions may be indicated when malignant transformation is suspected.

• Our approach to treatment

  Our approach to treating Maffucci syndrome is based on comprehensive, multidisciplinary care including orthopedics, vascular surgery, radiology and orthopedic oncology. Each case requires individual evaluation and planning of a treatment strategy that takes into account the specificity and extent of the disease, as well as the risk of malignant transformation. Long-term follow-up of the patient is also crucial.

• Treatment methods

  Treatment of Maffucci syndrome is mainly symptomatic and focuses on reducing pain, improving function and correcting deformities. Surgical treatment includes removal of symptomatic or suspicious bone lesions (especially those with suspected malignancy), correction of bone deformities and limb reconstruction. Treatment of hemangiomas includes surgical methods, laser therapy or sclerotherapy, depending on the location and clinical manifestations. In the case of malignant transformation, oncological treatment including radical resection and possibly chemo- and radiation therapy is necessary.

• Post-operative care

  After surgery, the patient requires comprehensive care, including pain control, physical rehabilitation, and regular orthopedic and radiological checks. Physiotherapy is essential to regain function and improve quality of life. As part of long-term follow-up, we recommend periodic imaging studies and oncology consultations to detect possible cancerous changes early.

• Treatment results

  The results of Maffucci syndrome are variable, depending on the extent of the lesions, the time of diagnosis and the presence of malignant transformation. Early diagnosis and regular follow-up allow faster intervention and reduce the risk of complications, thus improving the prognosis. Despite symptomatic treatment, patients often face chronic discomfort, although well-planned therapy can significantly improve quality of life. Regular follow-up helps reduce the risk of disease progression and complications.

Congenital Pseudarthrosis of the Tibia (CPT) is a rare orthopedic condition characterized by abnormal development of the tibia, leading to its pathological fracture and lack of fusion.

Main features of the condition:

• Early onset: Symptoms may be evident as early as birth or in the first years of a child's life
• Characteristic changes: Flexion of the tibia, thinning of its structure and tendency to pathological fractures
• Co-occurrence: Often accompanied by neurofibromatosis type 1 (von Recklinghausen's disease)

Congenital Tibial Arthroscopic Joint

• Description of the disease

  Congenital pseudarthrosis congenita tibiae (Latin: pseudoarthrosis congenita tibiae) is a rare, severe malformation characterized by a lack of normal fusion within the tibia. Already at birth or in the first months of life, a deformity of the limb can be noticed, most often in the form of flexion and interruption of the bone. In this place, an abnormal "joint" is formed - pseudarthrosis - which has no cartilage or joint capsule, but shows mobility, resulting in instability and often fractures.
  It most often occurs unilaterally and can be associated with neurofibromatosis type 1 (NF1). Congenital pseudarthrosis is difficult to treat and often leads to limb shortening, deformity and gait abnormalities.

• Diagnostics

  The diagnosis is based on:
  -History and physical examination - visible deformity of the shin, pathological mobility at the site of the bone break.
  -Imaging studies:X-ray - shows typical stenosis and interruption of bone, often trophied bone fragments.
  -Magnetic resonance imaging (MRI)-assessment of soft tissue condition, possible presence of fibroma.
  -Computed tomography (CT) - a more detailed evaluation of the anatomical structure, especially before surgical treatment.
  -Genetic testing - when NF1 is suspected.

• Our approach to treatment

  At Paley European Institute, we approach congenital pseudarthrosis with the utmost care and an individualized treatment plan. A comprehensive functional assessment and a plan for multi-stage surgical treatment, which often also requires long-term rehabilitation, is crucial. Our goal is not only to achieve bone fusion, but also to restore stability, equal limb length and the ability to move independently and without pain.

• Treatment methods

  Treatment of congenital pseudarthrosis is complex and lengthy. It includes:

  • Stabilization and osteosynthesis - the use of intramedullary nails, plates or external stabilizers (such as Ilizarov apparatus).
  • Bone grafts - autologous or allogeneic to stimulate adhesion.
  • Resection of lesions - removal of fibrous tissue inhibiting adhesion.
  • Lengthening of the limb - often necessary in subsequent stages when there is significant shortening.
  • Biological therapy - the use of growth factors (BMPs) or stem cells (experimentally).

• Post-operative care

  After surgical treatment, the patient remains under close supervision of a team of specialists.
  Care includes:
  -Regular radiological checks.
  -Intensive rehabilitation - strengthening muscles, learning to walk, preventing contractures.
  -Protection of the fusion site - orthoses, possibly plastering.
  -Psychological and educational care - especially important in school-aged children.

• Treatment results

  Multi-center experience, including ours in PEI, shows that successful treatment is possible - although it often requires several surgeries and years of guidance. Using modern orthopedic and reconstructive techniques, it is possible to achieve permanent bone fusion, correct the deformity and restore the patient's limb function. Early diagnosis and comprehensive treatment significantly increase the chance of good functional results and avoidance of amputation.

Congenital pseudarthrosis of the radius bone

• Description of the disease

  Congenital pseudarthrosis of the radius is a very rare developmental disorder involving abnormal formation of the radius bone, resulting in its disruption and lack of proper fusion - a so-called "pseudarthrosis joint" is formed, i.e. a site where physiological bone continuity is absent. Excessive mobility and deformity can occur at the site. This pathology can occur alone or, more often, in combination with a congenital pseudarthrosis of the elbow bone or in the course of neurofibromatosis type I (NF1). The deformity usually develops early, often noticed in the first months of life.

• Diagnosis
  The diagnosis is based on the clinical picture and imaging studies. Characteristic symptoms include shortening of the limb, deformity of the forearm, reduced mobility and pathological mobility at the site of the "joint".
  Diagnosis includes:
  - X-ray - shows discontinuity of the radius bone and possible deformity of adjacent structures.
  - MRI - helpful in evaluating soft tissues, marrow and detecting concomitant lesions.
  - Genetic testing - for suspected genetic syndromes, especially NF1.

•  Our approach to treatment

  At Paley European Institute, we focus on a comprehensive approach to treating congenital limb deformities. Our team of orthopedic surgeons, rehabilitation specialists and 3D planning engineers carefully analyze the patient's case, selecting a customized surgical plan. The key is not only to achieve bone fusion, but also to restore the function and axis of the limb. Depending on the age of the patient and the severity of the deformity, we implement staging strategies that often require advanced reconstructive technology.

•  Treatment methods

  Treatment is complex and usually surgical. The most common techniques are:
  - Resection of the pathological pseudarthrosis joint and stabilization of the bone (e.g. plate, intramedullary nail or wire fixation).
  - Bone grafts - autogenous (e.g., from the hip plate) or allogeneic.
  - Ilizarov technique or external braces - used for large bone defects or the need to lengthen the limb.
  - Free-vascular grafts from the fibula with vascular anastomosis - considered in difficult cases, especially when previous treatment has not resulted in adhesion.
  - The X-Union method - a modern technique developed by Dr. Dr. Paley, which involves the simultaneous use of:
  - a bone graft at the site of the pseudarthrosis joint,
  - Platelet anastomosis (internal stabilization),
  - active stimulation of the biology of adhesion (e.g., using autologous marrow cells),
  - and, if necessary, extension of the elbow bone to align length and axis.X-Union has a high success rate, even in cases refractory to other treatments. It has been successfully adapted to treat congenital pseudarthrosis of both the tibia and radius.
  - Treatment of concomitant ulnar bone deformity, if coexisting.

• Post-operative care

  After surgery, properly managed rehabilitation is key - initially immobilization, followed by gradual implementation of passive and active movements to restore range of motion and muscle strength. Follow-up X-rays help monitor the adhesion process. In some cases, further adjustments or reconstructions are necessary, especially in children of growing age. Our long-term care team monitors limb development, including for asymmetry and function.

•  Treatment results

  The prognosis depends on the severity of the defect, the age of the patient and the method used. The best results are obtained with early intervention and an appropriately selected surgical strategy. In many cases, stable bone fusion and good limb function can be achieved. Sometimes additional procedures are necessary as the child grows to correct secondary deformities or length differences.

Congenital pseudarthrosis of the clavicle

•  Description of the disease

  Pseudoarthrosis of the clavicle (pseudoarthrosis claviculae) is a rare, usually congenital deformity of the clavicle, involving a lack of bony fusion between the proximal and distal parts of the clavicle bone. Instead of a normal bony fusion, a fibrous joint-like tissue forms - hence the name "pseudarthrosis." The lesion usually occurs unilaterally, most often on the right side, and more often in girls than in boys. It can also occur bilaterally or coexist with other defects, such as Klippel-Feil syndrome.

• Diagnosis
  Diagnosis is based on:
  - physical examination - noticeable protrusion over the clavicle, mobility at the site of the abnormal connection, absence of pain;
  - radiograph (X-ray) - highlights a break in the continuity of the clavicle and rounded bony ends that do not fuse together;
  - computed tomography (CT) scan - when additional bones are suspected or in cases of surgery planning;
  - differential examinations - to differentiate from a complicated clavicle fracture or other congenital lesions

• Our approach to treatment

  At Paley European Institute, we treat clavicle pseudarthrosis as a condition that, despite its often asymptomatic course, may require treatment for functional or aesthetic reasons. Our team specializes in precise differential diagnosis and an individualized approach to deciding on surgical intervention, taking into account the child's age, clinical signs and possible coexisting defects.

• Treatment methods

  Treatment is usually surgical and includes:
  - resection of the fibrous tissues at the site of the pseudarthrosis,
  - fresh anastomosis of the ends of the clavicle using a bone graft (usually from the hip plate),
  - stabilization with a plate and screws or Kirschner wires - depending on the age and location of the lesion,
  - in rare cases - use of lengthening or 3D correction techniques.
  The procedure is usually planned after the age of 4, when bone growth allows successful anastomosis.

• Post-operative care

  After surgery, the patient wears immobilization (usually a Dessault dressing or orthosis) for about 4-6 weeks. This includes:
  - regular radiological checks to assess adhesion,
  - physiotherapy aimed at regaining full mobility of the shoulder and upper limb,
  - evaluation of scar healing and psychological support as needed (especially in older children).

• Treatment results

  The prognosis is very good - most patients achieve after surgical treatment:
  - full mobility of the shoulder,
  - abolition of the aesthetic deformity,
  - a very low rate of complications, such as lack of adhesion or infection,
  - improvement in quality of life and psychological well-being, especially during school and teenage years.

Lower limb deformities are a variety of anatomical disorders that affect the proper alignment and function of the legs. They can be congenital or acquired, and their proper treatment is key to maintaining proper gait biomechanics and preventing secondary health problems.

Knuckle Knees

•  Description of the disease

  A valgus knee (genu valgum), commonly referred to as "ixed" knees, is a defect in lower extremity alignment characterized by the knees moving closer together while the medial ankles of the feet remain distant. The condition may be physiological in children at certain stages of development, but the persistence or severity of the condition can lead to overloading of the knee joint, biomechanical abnormalities, and consequent pain, discomfort and premature degenerative changes.

• Diagnostics

  The basis of diagnosis is a detailed history and orthopedic examination, during which we evaluate the alignment of the limb axis, the range of joint mobility and any gait abnormalities. An essential part of diagnostic imaging are X-rays of the lower extremities in the standing position (the so-called lower limb axial radiograph), which allow precise determination of the angle of valgus. In some cases, magnetic resonance imaging (MRI) is additionally performed, especially when intra-articular structures are suspected.

• Our approach to treatment

  Our approach to treating valgus knees is based on an individualized assessment of the degree of deformity, the patient's age and physical activity and expectations. For minor deformities, we prefer conservative treatment, which includes rehabilitation and specialized orthotics. For more severe deformities and lack of improvement after conservative treatment, we suggest surgical treatment to restore the normal axis of the limb and relieve pressure on the joints.

• Treatment Methods

  For minor deformities, we use conservative methods: corrective exercises to strengthen the muscles of the lower limbs, physical therapy and the use of individually selected orthotics. For significant deformities, we recommend surgical treatment, which includes corrective osteotomy of the femur or tibia. It involves cutting the bone with precision, placing it in the correct position, and then fusing it together using orthopedic implants (plates and screws). In some cases, especially with advanced degenerative changes, we consider knee endoprosthesis.

  Hemiepiphysiodesis
  For children and adolescents whose bone growth has not yet completed, one of the available treatments is hemiepiphysiodesis. This is a minimally invasive surgical procedure to temporarily or permanently inhibit the growth of growth cartilage on one side of the bone. The procedure is performed on the convex side of the deformity, allowing for a gradual, controlled correction of the limb's axis as it continues to grow.
  The procedure can be performed using special clamps or figure-eight plates that block the growth of cartilage. The advantage of this method is its minimally invasive nature, short hospital stay and quick return to activity. It is particularly advantageous for patients of developmental age in whom the deformity is progressive.
  The timing of the procedure is crucial, taking into account the patient's growth potential and the degree of deformity. This requires a careful analysis of bone age and the expected remaining growth period.

•  Post-operative care

  After surgery, the patient remains under close medical and rehabilitation care. In the initial post-operative period, it is important to properly relieve pressure on the limb and provide thrombosis prophylaxis. Gradually, a rehabilitation program is implemented to restore range of motion, rebuild muscle strength and regain full gait function. Regular orthopedic check-ups allow ongoing evaluation of the healing process and possible adjustment of management

•  Treatment results

  The results of valgus knee treatment are usually very good. Conservative treatment produces satisfactory results in patients with milder deformities, effectively reducing pain and improving limb function. With surgical treatment, most patients experience a significant improvement in quality of life, reduction in pain and restoration of limb alignment. The ultimate outcome of treatment depends on the patient's age, the degree of deformity and consistent postoperative rehabilitation.

Inequality of Limb Length

• Description of the disease

  Lower limb length inequality is a condition in which one leg is shorter than the other, leading to abnormal body symmetry, abnormal gait and potential orthopedic problems. It can be congenital, resulting from developmental defects, or acquired, such as from trauma, infection, bone tumors or systemic diseases. Even a small difference in limb length can affect the comfort of life, generating chronic pain in the spine, hips or knees.

•  Diagnostics

  Diagnosis includes a thorough physical examination of the patient, along with assessment of the length of the lower extremities using clinical measurements and specialized imaging studies. X-rays of the lower extremities taken in the standing position (known as long axial radiographs of the limbs) are the standard, which allow precise determination of the extent of the inequality. In some cases, additional computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary, especially when accompanying bone or joint pathology is suspected.

• Our approach to treatment

  Our goal is to restore symmetry to the limbs, improve motor function and reduce or completely remove pain. We treat each case individually, taking into account the cause of the inequality, the patient's age and physical activity. Treatment is aimed at long-term improvement in quality of life, allowing patients to return to daily activities without restrictions.

• Treatment methods

  Treatment methods vary according to the degree of limb shortening and the age of the patient:
  -Conservative: orthotic insoles, specialized shoes with height compensation, used in cases of minor inequalities.
  -Surgical limb lengthening: most commonly used in larger length discrepancies. Includes techniques such as osteotomy with external stabilizers (ring or monolateral aparetics) or internal intramedullary nails (e.g., Precice magnetic nails).
  -Surgical shortening of the longer limb: used less frequently, mainly for moderate length discrepancies like epiphysiodesis.

• Post-operative care

  After limb lengthening surgeries, the patient remains under close orthopedic and physiotherapeutic control. Regular rehabilitation that includes exercises to strengthen muscles, improve joint range of motion and improve learning to walk properly is crucial. Follow-up visits make it possible to monitor the course of bone regeneration and detect possible complications early.

• Treatment results

  In most cases, treatment yields very good results, allowing patients to return to full mobility without pain or discomfort. Patients report a significant improvement in their quality of life, an increase in activity levels and the elimination of problems caused by limb inequality. The sooner treatment is undertaken, the more favorable the final results of therapy.

Splayed Knees

• Description of the disease

  Spatellar knee, or varum genu, is a defect in the axis of the lower extremities characterized by an outward tilt of the knees, resulting in a typical "bow" between the knees when the ankles of the feet are brought together. It is most common in children, but can also affect adults, especially in the course of osteoarthritis, post-traumatic or as a result of other metabolic conditions (such as rickets). Untreated knock-knees lead to uneven loading of the articular cartilage, which contributes to faster wear and tear of the joint surfaces and can cause chronic pain.

•  Diagnostics

  The diagnosis of bony knee is based on clinical evaluation and physical examination of the patient, during which the alignment of the lower extremities and gait pattern are analyzed. X-rays of the lower extremities taken in a standing position to assess the degree of axial deformity (angle of myelopathy) are crucial. In more complex cases, additional tests such as computed tomography (CT) or magnetic resonance imaging (MRI) are sometimes helpful, especially when ligament or cartilage damage is suspected.

• Our approach to treatment

  In treating the bony knee, an individualized approach to each patient is key. We focus on both the cause of the deformity and the patient's current stage and symptoms. In the initial stages, we use conservative treatment, which includes physiotherapy and orthopedic correction. For more advanced deformities, we recommend surgical treatment in the form of hemiepi, which aims to restore the normal axis of the lower extremities, relieve the pressure on the articular cartilage and eliminate pain.
  

Surgical options:
Hemiepiphysiodesis is a surgical procedure used to treat limb axis defects such as knock-knees. It involves temporarily inhibiting the growth of the growth cartilage (growth plate) on one side of the bone. It is a minimally invasive method of limb axis correction that allows the deformity to be gradually compensated for while the bone continues to grow.

This treatment:
-inhibits bone growth on one side, allowing the other side to "catch up" with growth
- is particularly effective in children during the growth period
- aims to restore the normal axis of the limbs and relieve the pressure on the articular cartilage

•  Treatment methods
  Treatment methods depend on the age of the patient, the degree of deformity and the presence of coexisting degenerative changes. Conservative treatment includes physiotherapy to strengthen the muscles of the lower extremities, corrective orthoses and orthotics. For advanced knock-knees, we use surgical methods, most commonly corrective osteotomy of the tibia or femur, which involves cutting the bone, correcting the limb's axis and stabilizing it with appropriate implants (plates or intramedullary nails). In exceptional cases, knee endoprosthesis may be necessary.
  
• Post-operative care

  After surgery, the patient remains under our close supervision, initially receiving painkillers and anticoagulant treatment. Rehabilitation begins in the first days after surgery and includes muscle strengthening exercises, improving the range of motion of the knee joint and gradual verticalization and learning to walk. The patient is advised to periodically relieve pressure on the operated limb with elbow crutches for several weeks, depending on the surgical technique used

• Treatment results

  Early initiation of appropriate treatment guarantees good or very good results. Surgical procedures can effectively correct the deformity, improve the function of the lower extremities and significantly reduce pain. Patients usually quickly return to full physical fitness and daily activities. Systematic rehabilitation and adherence to the doctor's recommendations ensure a long-term positive effect of the treatment.

Increased Anteversion of the Femoral Neck

• Description of the disease

  Increased anteversion of the femoral neck is a rotational disorder in the hip, consisting of an excessive angle between the neck and the shaft of the femur in the transverse plane. Under normal conditions, antegrade is about 10-20 degrees. In cases of increased antegrade, this angle can be much higher, leading to internal rotation of the entire lower limb. This is most often observed in children, who show a characteristic inward positioning of the feet ("pigeon gait"), more frequent stumbling, and difficulty in running and sports activities.

• Diagnostics

  Diagnosis is based on a thorough clinical examination and imaging. The doctor evaluates the range of motion in the hip joints, especially internal and external rotation. Characteristically, there is significantly increased alignment in internal rotation with reduced external rotation. Confirmation of the diagnosis is provided by a 3D CT scan of the lower extremities, which allows precise measurement of the angle of antegrade and assessment of the alignment of the entire limb (hip-knee-foot).

•  Our approach to treatment

  At Paley European Institute, we treat each child individually, taking into account age, severity of symptoms and degree of rotation. Increased anteversion can be a physiological phenomenon in young children that often corrects itself. In older children and adolescents in whom symptoms persist and rotation significantly affects quality of life, we consider surgical treatment. We always conduct a multi-specialist consultation, including limb axis analysis and gait evaluation, before making a decision.

•  Treatment methods

  In milder cases, observation and physiotherapy to promote a normal gait pattern are recommended. In cases of significantly increased antegrade or functional symptoms, we use surgical treatment. The most common is a rotational osteotomy of the femur - a procedure in which we break the bone, correct the rotation and stabilize it with special plates or intramedullary nails. The choice of stabilization method depends on the age of the child, the planned extent of correction and the preference of the surgical team.

•  Post-operative care

  After the operation, the patient is given close physiotherapy care. Usually the loading of the limb is gradual, depending on the stability of the anastomosis. Physiotherapy focuses on regaining range of motion, rebuilding muscle strength and re-educating gait. Patients and their families receive a thorough rehabilitation plan and support from the therapy team. Regular radiological follow-ups assess the healing process and the effects of the correction.

•  Treatment results

  A well-planned and performed rotational osteotomy yields very good functional and aesthetic results. Children gain improved limb alignment, gait stability and a better quality of life. It is often possible to return to physical activities and sports that previously caused difficulty. Complications are rare, and most patients achieve full function within a few months of surgery.

Femoral Retroversion, Lack of Fusion and Tibial Torsion

• Description of the disease

  Increased anteversion of the femoral neck is a rotational disorder in the hip, consisting of an excessive angle between the neck and the shaft of the femur in the transverse plane. Under normal conditions, antegrade is about 10-20 degrees. With increased antegrade, this angle can be much higher, leading to internal rotation of the entire lower limb. This is most often observed in children, who show a characteristic inward positioning of the feet ("pigeon gait"), more frequent stumbling, difficulty in running and sports activities

•  Diagnostics

  Diagnosis is based on a thorough clinical examination and imaging. The doctor evaluates the range of motion in the hip joints, especially internal and external rotation. Characteristically, there is significantly increased alignment in internal rotation with reduced external rotation. Confirmation of the diagnosis is provided by a 3D CT scan of the lower extremities, which allows precise measurement of the angle of antegrade and assessment of the alignment of the entire limb (hip-knee-foot).

• Our approach to treatment

  At Paley European Institute, we treat each child individually, taking into account age, severity of symptoms and degree of rotation. Increased anteversion can be a physiological phenomenon in young children that often corrects itself. In older children and adolescents in whom symptoms persist and rotation significantly affects quality of life, we consider surgical treatment. We always conduct a multi-specialist consultation, including limb axis analysis and gait evaluation, before making a decision.

•  Treatment methods

  In milder cases, observation and physiotherapy to promote a normal gait pattern are recommended. In cases of significantly increased antegrade or functional symptoms, we use surgical treatment. The most common is a rotational osteotomy of the femur - a procedure in which we break the bone, correct the rotation and stabilize it with special plates or intramedullary nails. The choice of stabilization method depends on the age of the child, the planned extent of correction and the preference of the surgical team.

• Post-operative care

  After the operation, the patient is given close physiotherapy care. Usually the loading of the limb is gradual, depending on the stability of the anastomosis. Physiotherapy focuses on regaining range of motion, rebuilding muscle strength and re-educating gait. Patients and their families receive a thorough rehabilitation plan and support from the therapy team. Regular radiological follow-ups assess the healing process and the effects of the correction.

•  Treatment results

  A well-planned and performed rotational osteotomy yields very good functional and aesthetic results. Children gain improved limb alignment, gait stability and a better quality of life. It is often possible to return to physical activities and sports that previously caused difficulty. Complications are rare, and most patients achieve full function within a few months of surgery.

Instability of the patellofemoral joint

•  Description of the disease

  Patellofemoral joint instability is a biomechanical disorder in which there is displacement (often subluxation or dislocation) of the patella relative to the condyles of the femur. It is most common in children, adolescents and young adults, especially those who are physically active. The main cause is improper cooperation between the bony and soft tissue structures that stabilize the patella. It can be the result of an anatomical defect (dysplasia of the femoral block, high patellar alignment, increased Q angle), muscle weakness or trauma

• Diagnostics

  The diagnosis is established on the basis of history (feeling of "escaping" patella, pain in the anterior part of the knee, instability during activity) and clinical examination (provocative tests, such as apprehension test). Diagnosis is supplemented by imaging studies:
  X-ray in axial projections of the patella - assessment of the height of alignment and glide of the patella,
  MRI - assessment of damage to cartilage, ligaments (especially MPFL - medial patellar trochlea),
  CT - in more advanced cases, for detailed analysis of limb axis and rotation.

• Our approach to treatment

  At Paley European Institute, we focus on pinpointing the cause of instability and tailoring treatment strategies individually. In children and adolescents, we take into account the dynamic changes associated with growth, while in adults we consider the stability of anatomical structures and activity levels. Our goal is not only to eliminate symptoms, but also to permanently correct the cause of instability to prevent recurrence and degenerative changes

• Treatment Methods

  Conservative treatment - indicated in cases of first incident or mild symptoms:
  -physiotherapy focused on strengthening the quadriceps muscle, especially the medial head,
  -proprioception and motion control training,
  -orthesis or taping to support patellar alignment.

  Surgical treatment - considered for recurrent dislocations, lack of improvement or presence of significant anatomical abnormalities:

  - MPFL ligament reconstruction (the most common procedure),
  -bone corrections: trochleoplasty (block molding), tibial tuberosity osteotomy (TTA shift), femoral or -tibial osteotomies for significant axis abnormalities,
  -A proprietary program of reconstruction of the upright apparatus by a la carte method - comprehensive simultaneous reconstruction of anatomical deviations such as disruption of femoral antetorsion, tibial torsion, plasty of the medial head of the quadriceps of the thigh, plasty of the tendon of the hamstring. The procedure allows weight bearing and full range of motion from the day after surgery.

•  Post-operative care

  After surgery, we follow an individualized rehabilitation program, starting with mobilization and isometric exercises, progressing to strength training, functional training and return to sports. We monitor the healing process with regular check-ups and imaging studies, and physiotherapists work closely with the medical team. Recovery time depends on the type of surgery - from a few weeks to several months.

Congenital limb defects are developmental abnormalities that arise during the fetal period and are present from birth. They can affect both upper and lower limbs, and can range in severity from minor anomalies to significant deformities.

The main categories of congenital limb defects include:

• Underdevelopment (hypoplasia): Incomplete development of part or all of a limb, leading to its reduced size
• Absence of a limb or part of a limb (aplasia): The complete lack of development of a specific body part
• Axial deformities: Misalignment of limb components relative to each other
• Extra elements (polydactyly): The presence of additional fingers or other structures

Congenital hypoplasia of the femur

• Description of the disease

  Congenital Femoral Deficiency (CFD) is a rare birth defect characterized by abnormal development of the femur. It can include shortening of the bone, deformity of the bone, instability or lack of contact between the hip joint and the acetabulum, and other concomitant defects such as absence of the patella, hip dysplasia or tibial deformities. CFD occurs unilaterally (usually) or bilaterally and varies in severity from mild shortening of the limb to significant osteoarticular deformities that prevent independent walking.

• Diagnostics

  The diagnosis of CFD is based on clinical examination of the child and diagnostic imaging. Even in the prenatal period, some cases can be suspected by ultrasound. After birth, X-rays of the lower extremities, assessment of the hip joint, and magnetic resonance imaging (MRI) or computed tomography (CT) scans are performed to accurately assess bone and joint structures. It is also important to perform tests of limb length and axis in the standing position. Diagnostics allow the defect to be classified according to systems such as the Aitken or Paley classification.

• Our approach to treatment

  At Paley European Institute, we approach each CFD case individually, taking into account the patient's needs, the degree of deformity and potential reconstructive options. Our goal is to maximize the function of the limb and allow the child to move independently - without pain and with minimal surgery throughout the growth period. We work as a multidisciplinary team, combining the experience of reconstructive orthopedists with physiotherapy and appropriate orthotic supplies.

• Treatment methods

  Treatment of CFD depends on the severity of the defect. In lighter cases, it is possible to use limb lengthening with telescopic nailing (PRECICE). In more complex forms, complex hip and knee reconstructions (e.g. superhip, superknee), stabilization of the limb axis and rotational corrections are used. Decisions are made together with the patient's family, after a detailed discussion of the treatment plan.

•  Post-operative care

  After surgery, regular monitoring of bone fusion, evaluation of the limb's axis and intensive rehabilitation are required. The PEI team provides ongoing physiotherapeutic, orthotic and psychological care. Patients often benefit from dedicated rehabilitation holidays and multi-specialty consultations to support their motor and social development. Limb lengthening is a lengthy process, but thanks to modern techniques and a personalized approach, it is possible to guide the patient with minimal discomfort.

• Treatment results

  Thanks to the advanced reconstructive techniques used in PEI, most CFD patients achieve very good functional results - walking, cycling and playing sports independently. Multi-stage treatment stretched over time allows therapy to be tailored to the child's growth rate. The results of treatment are usually permanent and allow full participation in daily life. The key to success is early diagnosis, good cooperation with the family and a consistent therapeutic plan.

Arrowhead hemimelia

• Description of the disease

  Fibular hemimelia is a congenital malformation of the lower limb involving partial or complete absence of the fibula. It is the most common of the lower extremity hemimelias and can occur unilaterally or bilaterally, although one leg is more commonly affected. It is usually accompanied by shortening of the limb, deformities of the foot (usually clubfoot), instability of the knee and ankle joint, and abnormal development of the tibia and tarsal bones.

• Diagnostics

  The diagnosis of sagittal hemimelia can be made prenatally with the help of ultrasound. After birth, thorough imaging examinations are performed: X-ray of the lower limbs in anteroposterior and lateral projection in the standing position (if possible), and MRI or CT scan if the structures of the knee and ankle joint need to be evaluated. It is also important to evaluate the limb length difference and classify the defect (usually according to the Paley classification) to help plan treatment.

• Our approach to treatment

  At Paley European Institute, we approach each case individually, analyzing both the anatomical features of the defect and the needs and goals of the child and family. Based on the team's experience and modern reconstructive methods, we develop a treatment plan that covers the entire development of the child - from infancy to the end of growth. Our goal is to preserve the limb, achieve its functionality and minimize the length difference.

•  Treatment methods
  
  Treatment depends on the severity of the defect and includes:
  - Early correction of the foot and ankle joint deformity - often as early as age 1, sometimes using the Ilizarov method or the innovative SUPERankle method developed by Dr. Paley.
  - Lengthening of the limb - usually planned in stages, using internal telescopic nails or computer-programmed external braces.
  _ Stabilization of the knee joint - SUPERknee treatment is performed if there is instability due to hypoplasia or absence of the fibular head or lack of cruciate ligaments.
  - In selected cases - amputation and prosthesis - if reconstruction is not promising for improvement of function, but this is now an increasingly rare choice thanks to reconstructive advances.

• Post-operative care

  After surgery, the child requires intensive rehabilitation under the guidance of a team of physiotherapists who specialize in orthopedic treatment for children. Maintaining range of motion, strengthening muscles and learning the correct gait pattern are key. Regular medical check-ups and imaging examinations help monitor the progress of treatment and plan the next steps.

• Treatment results
  Thanks to modern surgical and rehabilitation techniques, children with sagittal hemimelia have a chance to achieve full mobility, a symmetrical gait and participation in daily life and sports activities. In most cases, amputation can be avoided. The results of treatment depend on the severity of the defect, the timing of the start of therapy and the involvement of the team and family in the entire therapeutic process.

Tibial Hemimelia

• Description of the disease

  Tibial hemimelia is a congenital malformation characterized by partial or complete absence of the tibia. It is an extremely rare orthopedic defect, occurring at a rate of about 1 per million births. It is usually accompanied by shortening and deformity of the lower limb, instability of the knee and ankle joint, and deformities of the foot. The disease can range in severity from mild defects to complete absence of the tibia, severely limiting the function of the limb.

• Diagnostics

  Diagnosis of tibial hemimelia most often begins prenatally, with an ultrasound examination. After birth, a thorough clinical examination of the lower limb is performed, followed by imaging studies such as x-rays (X-rays), magnetic resonance imaging (MRI) or computed tomography (CT). The purpose of the diagnosis is to assess the degree of missing bones, accompanying deformities and concomitant malformations, such as in the knee and ankle joints.

• Our approach to treatment

  Our main goal in treating tibial hemimelia is to restore the best possible function of the lower limb, improve the patient's mobility and make the patient as independent as possible in everyday life. The treatment plan is tailored individually, taking into account the child's age, the severity of the defect and overall health. Treatment is carried out as a team, with the participation of pediatric orthopedic specialists, physiotherapists, prosthetists and psychologists.

• Treatment Methods

  Treatment methods for tibial hemimelia depend on the severity and extent of the deformity. In mild cases, it is possible to use reconstructive methods such as bone lengthening using a computer-controlled ring apparatus or intra-bony telescopic nails, and simultaneous correction of the limb axis. In more severe cases, complex reconstructive procedures are used, such as transfer of the fibula to the tibial position (known as fibular transfer). In the most severe cases, when the limb is not functional, below-knee amputation with subsequent prosthetic provision may be considered.

• Post-operative care

  Postoperative care after treatment of tibial hemimelia requires close cooperation between a team of specialists. The patient remains under regular orthopedic supervision, with periodic X-ray checks and evaluation of bone healing and regeneration. Intensive physiotherapy is crucial, aimed at improving range of motion, strengthening muscles, improving balance and learning to use a prosthesis, if necessary. Parents and patients are also educated on how to exercise independently and care for the limb.

• Treatment results

  The results of treatment of tibial hemimelia depend on the severity of the defect and the treatment method implemented. Early initiation of reconstructive treatment offers a chance to achieve satisfactory length and function of the limb, although multiple surgical interventions are usually necessary. With below-knee amputation and a properly selected prosthesis, patients often achieve very good mobility, physical activity and quality of life. An individualized approach and the involvement of the entire team of specialists is the key to optimizing treatment outcomes.

Tibial Hemimelia

• Description of the disease

  Tibial hemimelia is a congenital malformation characterized by partial or complete absence of the tibia. It is an extremely rare orthopedic defect, occurring at a rate of about 1 per million births. It is usually accompanied by shortening and deformity of the lower limb, instability of the knee and ankle joint, and deformities of the foot. The disease can range in severity from mild defects to complete absence of the tibia, severely limiting the function of the limb.

• Diagnostics

  Diagnosis of tibial hemimelia most often begins prenatally, with an ultrasound examination. After birth, a thorough clinical examination of the lower limb is performed, followed by imaging studies such as x-rays (X-rays), magnetic resonance imaging (MRI) or computed tomography (CT). The purpose of the diagnosis is to assess the degree of missing bones, accompanying deformities and concomitant malformations, such as in the knee and ankle joints.

• Our approach to treatment

  Our main goal in treating tibial hemimelia is to restore the best possible function of the lower limb, improve the patient's mobility and make the patient as independent as possible in everyday life. The treatment plan is tailored individually, taking into account the child's age, the severity of the defect and overall health. Treatment is carried out as a team, with the participation of pediatric orthopedic specialists, physiotherapists, prosthetists and psychologists.

• Treatment Methods

  Treatment methods for tibial hemimelia depend on the severity and extent of the deformity. In mild cases, it is possible to use reconstructive methods such as bone lengthening using a computer-controlled ring apparatus or intra-bony telescopic nails, and simultaneous correction of the limb axis. In more severe cases, complex reconstructive procedures are used, such as transfer of the fibula to the tibial position (known as fibular transfer). In the most severe cases, when the limb is not functional, below-knee amputation with subsequent prosthetic provision may be considered.

• Post-operative care

  Postoperative care after treatment of tibial hemimelia requires close cooperation between a team of specialists. The patient remains under regular orthopedic supervision, with periodic X-ray checks and evaluation of bone healing and regeneration. Intensive physiotherapy is crucial, aimed at improving range of motion, strengthening muscles, improving balance and learning to use a prosthesis, if necessary. Parents and patients are also educated on how to exercise independently and care for the limb.

• Treatment results

  The results of treatment of tibial hemimelia depend on the severity of the defect and the treatment method implemented. Early initiation of reconstructive treatment offers a chance to achieve satisfactory length and function of the limb, although multiple surgical interventions are usually necessary. With below-knee amputation and a properly selected prosthesis, patients often achieve very good mobility, physical activity and quality of life. An individualized approach and the involvement of the entire team of specialists is the key to optimizing treatment outcomes.

Blount's disease

• Description of the disease

  Blount's disease (from Latin: tibia vara) is a growth disorder of the medial part of the proximal tibial epiphysis, which leads to progressive knee valgus (varus gene). It is most common in children in two forms: infantile (under 3 years old) and adolescent (6-13 years old). The disease is associated with uneven bone growth, where the medial portion stops growing properly, causing the leg to curve to the inside of the

• Diagnostics

  The diagnosis of Blount's disease is based on:
  - History and physical examination, taking into account myelopathy and asymmetry of the limbs,
  - X-ray of the lower extremities in AP and lateral projection - characteristic changes include marked irregularity and fragmentation of the medial part of the tibial epiphysis and an above-normal angle between the neck and shaft of the bone,
  - Metaphyseal-diastral angle measurements (Drennan angle) - above 11° suggests Blount,
  - In some cases, MRI is performed, especially if surgical intervention is planned.

• Our approach to treatment
  At our center, we take a holistic and personalized approach, assessing the degree of deformity, the patient's age, the presence of comorbidities (e.g., obesity, limb asymmetry), and growth potential. Together with the therapeutic and orthotic team, we plan treatment and long-term follow-up.

• Treatment Methods
  

  Depending on the age of the patient and the degree of deformity, we use:
  - Conservative treatment (only in the youngest patients with a minor marrow): Specialized orthoses worn overnight or all day, physiotherapy, weight control.
  - Operative treatment:
  - Hemi-epiphysis - temporarily blocking the growth on the lateral side of the growth plate to restore balance.
  - Corrective osteotomy of the tibia - in older children and adolescents with advanced deformity. Can be performed classically or with an external fixator (ExFix) or the PRECICE system for more controlled lengthening and correction.
  - In severe cases - multi-stage reconstructions in LLRS syndrome.

•  Post-operative care

  After surgery, the patient is subject to:
  - Regular radiological follow-up,
  - Intensive physiotherapy aimed at correct limb alignment and gait re-education,
  - Orthotic support, if required (e.g., orthoses or orthotics),
  - Limb length monitoring, especially for children in the growth phase.
  We work with the family and therapy team to provide comprehensive care at home and in the school setting.

• Treatment results

  Prognosis in Blount's disease depends on the timing of treatment:
  - Early diagnosis and treatment - very good results, possibility of avoiding surgery,
  - Surgical treatment in older children and adolescents - usually successful, but may require further correction,
  - Lack of treatment - leads to progressive deformity, pain, instability of the knee joint and degenerative changes in adulthood.
  Thanks to the experience of the LLRS team and modern reconstructive techniques, we achieve very good results even in difficult and delayed cases.

Congenital defects of the upper limbs are developmental abnormalities that arise in fetal life and are present from birth. They can range from the absence of limb elements (aplasia), their underdevelopment (hypoplasia), to the presence of additional structures (polydactyly) or adhesions between fingers (syndactyly). These defects often significantly affect a child's hand function, precision of movement and independence. The most common disorders include radial hemimelia, absence of the thumb, syndactyly, polydactyly and amniotic band syndrome. Treatment depends on the type and extent of the defect - most often requiring reconstructive surgery and long-term rehabilitation to achieve the best possible function of the limb.

Radial hemimelia (clubhand)

• Description of the disease

  Radial hemimelia, also known as clubhand or radial dysplasia, is a rare congenital defect of the upper limb involving partial or complete absence of the radius bone. It is accompanied by shortening and deformity of the forearm and deviation of the hand toward the thumb. Many children also have underdevelopment of the thumb, forearm muscles and soft tissues on the radial side. The condition can occur unilaterally or bilaterally, and is often associated with other genetic syndromes (e.g. VACTERL, TAR, Holt-Oram).

•  Diagnostics

  Diagnosis of radial hemimelia is most often possible prenatally through ultrasound. After birth, the diagnosis is confirmed on the basis of a clinical examination and an X-ray of the upper limb, which shows the extent of underdevelopment of the radius bone. In addition, imaging tests are performed to assess the development of the wrist, ulna and fingers. Genetic testing and diagnosis of associated systemic defects are also indicated.

• Our approach to treatment
  At Paley European Institute, we treat radial hemimelia as a complex deformity requiring a comprehensive multidisciplinary approach. Early assessment of the extent of the defect and the creation of a customized treatment plan, which can include both conservative and surgical therapy, is crucial. Our goal is not only to improve limb alignment and hand function, but also to enable the child to be as independent as possible in daily activities.

• Treatment methods
  The primary and most common method of surgical treatment of the more severe forms of radial hemimelia is ulnarization, developed and refined by Dr. Dr. Paley. The procedure involves medialization (medial displacement) of the wrist to the ulna, which stabilizes the hand, prevents further deviation and improves grip function. In some cases, soft tissue stretching is also used prior to surgery (e.g., with an Ilizarov distractor) to allow for safe ulnarization.

  Additional procedures may include:
  - reconstruction or thumb plasty,
  - cutting or lengthening of tendons,
  - corrective osteotomies of the ulnar bone.

• Postoperative care
  After the ulnarization procedure, the limb is immobilized in a cast or orthosis for a period of several weeks. Intensive rehabilitation is then introduced to improve the range of motion, muscle strength and function of the hand. Cooperation with a physiotherapist and regular medical check-ups are key to achieving the best possible results. In some cases, further corrective treatments are needed as the child grows.

•  Treatment results
  Ulnarization significantly improves wrist alignment and hand stability. After treatment, children gain better control of movement, grip and the ability to perform daily activities. The aesthetic results are also satisfactory. Early surgical intervention, combined with comprehensive rehabilitation, makes it possible to achieve lasting functional improvement and prevent the deformity from worsening with age.

No thumb

• Description of the disease
  Lack of thumb (thumb aplasia or thumb hypoplasia/aplasia) is a congenital malformation of the upper limb, consisting of partial (hypoplasia) or complete (aplasia) absence of the thumb. It can occur unilaterally or bilaterally and can be isolated or accompany congenital syndromes, such as TAR syndrome, VACTERL syndrome or cardiac malformation syndromes.The thumb plays a key role in hand function - it enables pincer grasp and oppositions to the fingers, which is the basis for precise movements. The lack of a thumb significantly limits the function of the upper limb and affects the child's independence in daily activities.
  

• Diagnosis
  Diagnosis is most often made as early as in the neonatal period or even prenatally on ultrasound. After birth, the following is performed:
  - A thorough physical examination of the upper limb and hand function,
  - X-rays of the hand and wrist to assess the presence of bony structures,
  - Cardiac and abdominal ultrasound (in case of suspected concomitant defects),
  - Genetic consultation if congenital syndrome is suspected.

  Hypoplasia/aplasia of the thumb is classified according to the Blauth system (type I-V), which helps in choosing the right surgical treatment strategy.

• Our approach to treatment
  At our center, each case is approached individually, taking into account the age of the child, the severity of the defect, the presence of other deformities and functional needs. A team of specialists in pediatric orthopedics, hand surgery and rehabilitation work together to plan the optimal treatment.
  Our goal is to enable the child to use his or her hand as functionally as possible, both in everyday life and in the future professional and social life.
  

• Treatment Methods
  Treatment depends on the degree of hypoplasia:
  - Type I-II (mild hypoplasia): usually conservative treatment (rehabilitation) or minor surgical procedures are used to improve the stability and function of the thumb.
  - Type III-V (absence of bony structures, instability, no thumb): usually polyplasia, i.e. transformation of the index finger into a new, functional thumb, is required.
  - Additional procedures may include correction of accompanying wrist deformities, tendon transfers or joint reconstruction.
  Pollicization is most often performed between the 12th and 24th months of a child's life, when the structures are still flexible and the brain is highly adaptable.

• Post-operative care
  After surgery, intensive and long-term rehabilitation by experienced hand therapists is crucial. It usually includes:
  - Physiotherapy and occupational therapy (grasping, counterbalancing exercises),
  - Individualized home exercise plan,
  - Orthopedic checks and any further functional modifications.
  Parents are included in the rehabilitation process, learning how to support their child in developing new manual skills.

   

• Treatment results
  With properly planned surgical treatment and rehabilitation, children with a missing thumb achieve very good functional results. The polyglided finger can successfully play the role of a thumb - enabling grasping, manipulation of objects and independence in daily life.
  Many patients experience no limitations in function and activities - from writing to playing sports. The key to success is early diagnosis, the experience of the team and systematic post-operative care.

Syndactylia

•  Description of the disease

  Syndactyly is a congenital defect of the upper limb involving the fusion of two or more fingers of the hand. It can involve only the skin (cutaneous syndactyly) or also bones and other structures (bony syndactyly). It is one of the most common malformations of the hand, occurring with a frequency of about 1:2,000 births. It can occur alone or as part of congenital syndromes such as Apert syndrome or Poland syndrome.

Syndactylia may be:

• - Complete - the connection covers the entire length of the fingers
• - Incomplete - only partial connection
• - Simple - fusion of skin and soft tissues only
• - Complex - fusion also involves bones, tendons, vessels and nails

•  Diagnostics

  The diagnosis is usually made immediately after birth based on the clinical picture. In complex cases, imaging studies are necessary to plan treatment:
  - X-ray of the hand - to assess the presence of bony fusion
  - Ultrasound or MRI - in rare cases to evaluate soft tissues
  - Genetic testing - if a congenital syndrome is suspected

•  Our approach to treatment

  In PEI, each child with syndactyly is evaluated individually by a team of hand surgeons, pediatric orthopedists and rehabilitation specialists. It is crucial to consider the child's age, the type of fusion and the potential impact on hand function. We always aim to achieve optimal hand function and aesthetics, avoiding the risk of secondary deformities.

• Treatment methods

  Treatment is purely surgical and usually planned between 6 and 18 months of a child's life.
  We use modern surgical techniques:
  - Toe separation with simultaneous skin reconstruction
  - Use of skin grafts - usually from the groin to avoid contracture scarring
  - Reconstruction of the interdigital folds to improve function and appearance

  In complex cases, it is necessary:
  - Reconstruction of tendons, ligaments, nails
  - Osteotomies for bony deformities

• Post-operative care

  After surgery, the hand is immobilized in a plaster dressing or splint for about three weeks.
  Then the stage begins:
  - Intensive physiotherapy - improving range of motion and function
  - Scar evaluation and treatment - application of silicone gels, massages
  - Control consultations - monitoring of hand growth and possible recurrence of adhesions

• Treatment results

  The prognosis after surgical treatment is very good, especially for simple forms of syndactyly.
  The best results are obtained with:
  - Early intervention
  - Precise tissue separation
  - Regular rehabilitation
  For complex adhesions, staged treatment may be necessary, and functional results depend on the severity of the defect.

Polydactylia

•  Description of the disease

  Polydactyly is a congenital defect involving the presence of extra fingers or toes. It can occur as an independent abnormality or be part of genetic syndromes. The extra fingers may be fully developed and functional or reduced to small skin or bone outgrowths. It is most common in the hands - usually on the side of the little finger (known as postaxial polydactyly), less often on the side of the thumb (preaxial), and least often in the central part of the hand (middle).

• Diagnostics

  The diagnosis of polydactyly is usually made immediately after birth, based on a physical examination. Imaging studies, mainly x-rays of the hand or foot, are performed to determine the exact structure of the extra finger. Diagnosis may be expanded to include genetic consultation, especially in cases of association of polydactyly with other birth defects or suspected genetic syndrome.

•  Our approach to treatment

  At Paley European Institute, we approach each case individually. We carefully analyze the structure of the extra toe and its impact on the function of the hand or foot. We plan treatment to preserve the best possible function and aesthetics of the limb. Our specialists work closely with parents and the treatment team to prepare the optimal surgical and rehabilitation plan.

•  Treatment methods

  Treatment of polydactyly is usually surgical and takes place in early childhood - usually between the ages of 6 and 12 months - to allow normal development of hand or foot function.
  The treatment consists of:
  - Removal of the extra toe, with appropriate reconstruction of the soft tissues and, if necessary, the skeletal system.
  - Correction of ligaments, tendons and skin to ensure the stability and mobility of the retained structures.
  - In more complex cases, reconstruction of the joint or axis of the finger may be necessary.

•  Post-operative care

  After surgery, the child wears a bandage or stabilizing splint for several weeks, and then begins the rehabilitation process. Physiotherapeutic support is key to regaining full function of the hand or foot. Follow-up visits to the pediatric orthopedist allow monitoring the effects of treatment and possible modifications to therapy.

• Treatment results

  The prognosis after surgical treatment of polydactyly is very good. Most children achieve full function of the hand or foot and a very good aesthetic result. Early intervention minimizes the risk of complications and promotes harmonious development of the child. In a few cases, recurrence of the deformity is possible, which can be corrected with further treatment.

Amniotic band syndrome (amniotic band syndrome)

• Description of the disease
  Amniotic Band Syndrome (ABS) is a rare birth defect resulting from intrauterine damage to the amniotic membrane - the thin membrane that surrounds the fetus. The result is the formation of fibrous bands that can wrap around parts of the developing baby's body (most often limbs), causing compression, restricted blood flow, deformities and sometimes amputations. Symptoms range from mild skin dimpling to severe malformations.

• Diagnostics
  Prenatal diagnosis is based on ultrasound, which can reveal the presence of amniotic bands and possible deformities of the fetus' limbs or face. After birth, the diagnosis is made on the basis of physical examination - slender, annular constrictions on the limbs, deformities of the fingers, adhesions (syndactyly) or congenital amputations are characteristic. If necessary, imaging studies (e.g., X-ray, MRI) are also performed to assess the depth of the lesions.

• Our approach to treatment
  At PEI, we treat each ABS patient on an individual basis, taking into account the location and extent of the deformity, functional needs and the child's age. Cases are discussed in an interdisciplinary team of orthopedic surgeons, hand therapists and rehabilitation specialists. The goal of treatment is not only to improve the function of the limb, but also the aesthetics and psychological comfort of the child

• Treatment methods
  Treatment of amniotic band syndrome may include:
  - Plastic and reconstructive surgery - release of the bands, soft tissue reconstruction, skin grafts.
  - Orthopedic procedures - correction of bone and joint deformities, limb lengthening, improvement of hand/foot axis and function.
  - Phalangeal transfer from the toe to the hand - in cases of congenital amputations or severe deformities of the fingers, it is possible to transplant a phalanx (usually from the second toe) to reconstruct the radius of the hand, which significantly improves the function of grip and precise hand movements.
  - Supportive therapies - individual physiotherapy, occupational therapy and orthopedic supplies (orthoses, orthotics)

• Postoperative care
  After surgery, intensive rehabilitation is key - depending on the location of the lesions, this can include hand therapy, range-of-motion exercises, muscle strengthening and learning new movement patterns. Parents receive full educational support and instruction in home exercises. If necessary, the child can be cared for by the therapy team as part of rehabilitation camps at our Neurocenter.

• Treatment results
  Prognosis depends on the severity of the lesions. In cases of superficial bands and limited deformities, treatment results are very good - children regain full mobility and limb function. In more severe cases, we aim to maximize the child's independence and improve quality of life. With modern surgical techniques and comprehensive rehabilitation care, we can achieve significant improvements in limb function and aesthetics.

Spinal conditions in adults are a group of health problems that affect patients' quality of life and mobility. They can be the result of age-related degenerative processes, trauma, or poor posture. Early diagnosis and appropriate treatment are key to achieving the best therapeutic results.

Adult Scoliosis

• Description of the disease

  Adult scoliosis is a curvature of the spine occurring in patients who have completed bone growth. It can be a continuation of scoliosis diagnosed in childhood (idiopathic adult scoliosis) or arise secondary to degenerative changes in the spine (degenerative scoliosis). Patients often report back pain, feelings of fatigue, balance disorders, and in advanced cases there are neurological problems due to pressure on nerve structures.

• Diagnostics

  Diagnosis of adult scoliosis is based on a thorough clinical and imaging examination. Standard x-rays of the entire spine (standing) are taken to assess the degree of curvature and its location. The diagnosis is supplemented by imaging studies such as magnetic resonance imaging (MRI), computed tomography (CT) or CT myelography, which are used to assess degenerative changes, the condition of the intervertebral discs and any compression of the spinal cord or nerve roots.

• Our approach to treatment

  In the treatment of adult scoliosis, an individualized approach is key, taking into account the degree of deformity, the presence of pain, neurological disorders, and the patient's expectations. Our goal is to restore or improve spinal function, reduce pain, improve the patient's quality of life and prevent further progression of the disease.

• Treatment methods

  Treatment of adult scoliosis is divided into conservative and surgical. For less severe deformities and moderate pain, conservative treatment including physiotherapy, postural muscle strengthening exercises, manual therapy, analgesic and anti-inflammatory pharmacotherapy and possibly an orthopedic corset is recommended.

  Surgical treatment is considered in cases of significant spinal deformity, severe pain and neurological symptoms. The surgical procedure consists of correcting the curvature of the spine with the use of instrumentation (stabilizing implants), often combined with stiffening (fusion) of the vertebrae affected by the deformity.

  Postoperative care
  After surgery, the patient stays in the hospital from a few days to about a week. Intensive rehabilitation begins in the first few days after surgery. The rehabilitation program includes patient mobilization, breathing exercises, strengthening exercises and learning ergonomic principles for daily living. For several months, the patient is advised to limit physical activity, especially avoiding heavy lifting and twisting movements of the spine.

• Treatment results

  Treatment of adult scoliosis results in a significant improvement in quality of life for most patients. Therapy results in a reduction or complete resolution of pain, improved posture, mobility and neurological function. Patients require regular clinical and imaging follow-ups after surgical treatment to assess the stability and effectiveness of the procedure performed. Long-term results are generally satisfactory, although the full effect of treatment depends on the severity of the deformity and the individual characteristics of the patient.

Narrowing of the Spinal Canal

•  Description of the disease

  Spinal canal stenosis (spinal canal stenosis) is a condition involving a reduction in the diameter of the spinal canal, in which the spinal cord and nerve roots run. It can occur at the cervical, thoracic or lumbar levels of the spine, with the lumbar and cervical segments most commonly affected. Stenosis can be congenital (rare) or, much more often, acquired as a result of degenerative changes, intervertebral disc disease, ligamentous hypertrophy, osteophytes or after trauma and surgery.
  Symptoms depend on the location and severity of the stenosis - they can include back pain, numbness, limb weakness, problems with walking or sphincter control.

•  Diagnostics

  The diagnosis is based on a thorough medical history and neurological examination. Symptoms such as neurogenic chroma, muscle weakness or sensory disturbances direct attention to suspected stenosis.
  -The gold standard for diagnosis is imaging studies:
  -Magnetic resonance imaging (MRI) - best images nerve structures and the degree of compression,
  -Computed tomography (CT)-especially useful for bone lesions,
  -RTG of the spine - general assessment of curvature and alignment of the vertebrae.
  Sometimes myelography is also performed in cases of diagnostic difficulty.

• Our approach to treatment

  At our center, we focus on assessing the patient holistically and tailoring therapy to the individual - taking into account the clinical picture as well as lifestyle, expectations and other accompanying conditions. We focus on conservative treatment in the first stage, but we do not hesitate to implement surgical treatment if the complaints significantly limit the patient's daily functioning or threaten neurological function.

• Treatment methods
  Conservative treatment (first-line therapy):
  -physiotherapy focused on stabilization and stretching,
  -anti-inflammatory, muscle relaxant and analgesic drugs,
  -epidural steroid injections (temporary symptom relief),
  -lifestyle and ergonomic modification.
  -Surgical treatment - indicated when conservative treatment has failed or when neurological symptoms progress.

Most common procedures:

Laminectomy - removal of the posterior portion of the vertebra to decompress the canal,
Foraminotomy - widening of intervertebral openings,
Spinal stabilization - for instability (e.g., titanium screws and rods),
Endoscopic microsurgery - minimally invasive techniques for faster recovery.

•  Post-operative care

  After surgery, the patient undergoes an individually tailored rehabilitation program that includes:
  - pain control and prevention of complications,
  -learning proper movement and strengthening postural muscles,
  -regular follow-up visits with assessment of neurological progress and healing.
  -Recovery time depends on the extent of surgery, the patient's age and overall health.

• Treatment results

  When the treatment method is properly selected, the results are very good - especially in patients operated on before permanent neurological damage occurs. Most patients experience a significant improvement in their quality of life after surgery, reducing pain and regaining mobility. Maintaining the effects of treatment also depends on long-term rehabilitation and attention to spinal hygiene.

Disc hernia

• Description of the disease

  A herniated disc, also known as a discopathy, is a disorder of the intervertebral disc - an elastic structure located between the vertebrae of the spine. As a result of degeneration or overload, the outer layer of the disc (fibrous ring) is damaged, causing its inner, gelatinous part (nucleus pulposus) to move outward. This can lead to pressure on nerve structures (such as spinal nerve roots), causing pain, numbness, muscle weakness or other neurological symptoms. It most commonly occurs in the lumbar region, but can also affect the cervical or thoracic regions

• Diagnosis
  Diagnosis of a herniated disc is based on a detailed medical history and neurological examination.
  Imaging studies are crucial:
  -Magnetic resonance imaging (MRI) - the gold standard for diagnosing a herniated disc, shows both the structure of the disc and the degree of nerve compression.
  -Computed tomography (CT)-used when MRI is not possible.
  -RTG of the spine - does not visualize the disc itself, but can indicate changes in vertebral alignment.
  -EMG (electromyography) - used in assessing nerve damage

•  Our approach to treatment

  At our center, we focus on causal and functional treatment. We evaluate each case individually, taking into account not only the diagnostic picture, but also the patient's clinical symptoms, lifestyle and expectations. We often implement a comprehensive approach combining conservative treatment with modern surgical methods if non-invasive treatment does not work

•  Treatment methods

  Conservative treatment:
  -rest and avoidance of overload,
  -pharmacotherapy (painkillers, anti-inflammatory drugs, drugs to reduce muscle tension),
  -physiotherapy and rehabilitation (strengthening exercises, neuromobilizations, manual therapy),
  -pain blocks (e.g., epidurals).

• Operative treatment:

  -microdiscectomy - the most common procedure to remove a hernia through a small incision,
  -endoscopic discectomy - a minimally invasive technique performed through an access of several millimeters,
  -neural decompression,
  -in some cases spinal fusion (stabilization) when there is instability or coexisting degenerative changes.

•  Post-operative care

  After surgery, patients undergo intensive physiotherapy, aimed at strengthening the deep muscles of the spine, improving posture and learning ergonomics of movement. Lifting and intense exertion are avoided for several weeks. It is also important to educate the patient on how to prevent recurrence through proper lifestyle and regular physical activity.

• Treatment results
  Most patients achieve significant improvement or complete resolution of symptoms after surgical treatment, especially when the decision to proceed is made at the right time. With conservative treatment, about 80% of patients experience improvement within 6-12 weeks. A key factor influencing long-term outcomes is the patient's commitment to rehabilitation and lifestyle modification.

Foot deformities are a group of conditions affecting the structure and function of the foot, which can be congenital or acquired. Proper diagnosis and treatment is key to ensuring proper foot development and function.

Horse-and-Spotted Foot

•  Description of the disease

  Equinovarus foot (Latin: Pes equinovarus) is one of the most common congenital orthopedic deformities, which consists of a multiplanar deformity of the foot. Characteristic features include plantar flexion (horse foot positioning), inversion (supination) and forefoot adduction, which leads to an "inward and downward" positioning of the foot. In severe cases, the child may lean against the lateral edge or dorsum of the foot. The deformity can occur unilaterally or bilaterally and can be isolated (idiopathic) or accompany other syndromes (e.g., arthrogryposis, meningo-spinal hernia).

•  Diagnostics

  Diagnosis of clubfoot is possible prenatally with the help of an ultrasound, usually in the second trimester of pregnancy. After birth, the diagnosis is confirmed by physical examination. The degree of deformity, range of motion, flexibility of the foot and the presence of associated symptoms are assessed. If a secondary form is suspected, further diagnostic imaging (X-ray, MRI) and neurological tests are performed.

• Our approach to treatment

  At Paley European Institute, our goal is to restore a functional, flexible and pain-free foot that allows the child to walk and develop properly. We use an individualized approach, taking into account the patient's age, the degree of deformity and response to treatment. Priority is given to starting therapy as early as possible - preferably in the first days of life. Treatment is carried out by an experienced team of specialists in pediatric orthopedics and rehabilitation.

• Treatment Methods

  The gold standard in the treatment of clubfoot is the Ponseti method, which includes:
  - weekly redressing and casting to gradually correct the deformity (usually 5-7 casts),
  - cutting the Achilles tendon (tenotomy) on an outpatient basis when the equine component requires correction,
  - wearing a derotation splint (Dennis-Brown) 23 hours a day for the first 3 months, and then at night and during naps until age 4.

  In refractory or recurrent cases, surgical treatment is an option, which may include tendon lengthening, muscle transfers or bone corrections.

•  Post-operative care

  After completion of the plaster treatment and possible surgery, the child continues to wear the orthosis and undergoes regular follow-ups. Physiotherapy and education of parents on how to properly wear the splint and monitor for signs of recurrence is a key component. Our team provides comprehensive care - both medical and therapeutic - at every stage of treatment.

• Treatment results

  With early and consistent therapy, most children with idiopathic clubfoot achieve very good functional results. The foot is flexible, pain-free and allows normal motor development. The Ponseti method has a success rate of up to 95% in idiopathic cases. The key to maintaining treatment results is strict adherence to the recommendations for wearing the orthosis and regular follow-up visits.

Congenital Vertical Alignment of the Vestibular Bone CVT.

• Description of the disease

  Congenital Vertical Talus (CVT, or Congenital Vertical Talus) is a rare, complex congenital defect of the foot in which the ankle bone is positioned vertically and the other bones of the foot are displaced dorsally relative to it. The result is a stiff, deformed foot resembling the so-called "rocker-bottom foot," where the sole of the foot is convex and the forefoot is strongly elevated. This deformity often occurs bilaterally and can be isolated or accompany neuromuscular diseases such as arthrogryposis, Prader-Willi syndrome or spina bifida.

• Diagnostics

  The diagnosis of CVT includes clinical evaluation and imaging confirmation. The characteristic appearance of the foot is already noticeable in a newborn or infant. Typical symptoms include stiffness, lack of passive correction, and a characteristic protrusion of the sole. For a complete diagnosis, foot X-rays in lateral projection - preferably in dynamic projection (in sole and dorsiflexion), which show vertical alignment of the ankle bone, displacement of the scaphoid bone and lack of coverage of the ankle-ankle joint - are necessary.

• Our approach to treatment

  At Paley European Institute, we take an individualized and multi-specialty approach to CVT. Early diagnosis and treatment in the first months of life, before the deformity becomes permanent, is crucial. Treatment is provided by an experienced team of pediatric orthopedists, often in collaboration with neurologists if CVT is accompanied by other neurological disorders. Our goal is to achieve a functional, plantigrade (meaning correctly aligned) and pain-free foot.

• Treatment methods

  The basis of CVT treatment is a method based on a modification of the Ponseti technique, which includes:
  - A series of redressions and corrective casts, changing the position of the foot gradually, in a controlled manner.
  - A surgical procedure involving release of the ankle-ankle joint using the Dobbs method and temporary fusion of the joint with a Kirschner (K-wire), which allows permanent positioning of the scaphoid bone on the ankle bone.
  - After the procedure, an orthosis is used to maintain the correction, similar to the treatment of the clubfoot

•  Postoperative care
  After surgery, the child wears a cast for about 4-6 weeks, and then transitions to wearing an orthosis that maintains the correction achieved and prevents recurrence. Parents are educated on how to properly wear and control the orthosis. Regular orthopedic check-ups and, if necessary, rehabilitation to help develop motor function are also essential.

•  Treatment results

  With early diagnosis and proper treatment, the results are very good. In most patients, we achieve a permanent correction of the foot that allows normal function, wearing shoes and physical activity without pain. Recurrence of the deformity is rare but possible, especially in cases associated with neurological disorders - which is why long-term orthopedic follow-up is so important.

Flat-footedness

• Description of the disease

  Flat foot is one of the most common foot deformities in children and adolescents. It is characterized by a lowering of the medial vault (longitudinal arch of the foot) and a valgus position of the heel, which means that the heel tilts outward. In addition, external rotation of the forefoot and displacement of the ankle bone medially and downward are often observed. It can be flexible (when the deformity disappears when standing on tiptoe) or rigid (fixed).
  In most cases it is a physiological variant in preschool children, but in some situations it can lead to pain, reduced function and secondary deformities of the knees, hips or spine.

•  Diagnostics

  Diagnosis begins with a detailed clinical examination, including an evaluation of foot alignment in standing and during gait, a toe standing test and a check of foot flexibility. Imaging studies are crucial, especially x-rays of the feet in weight-bearing projections. If warranted, we also perform computed tomography (CT) or magnetic resonance imaging (MRI), especially if we suspect a stiff flat-foot or the presence of a tarsal bone coalition.

•  Our approach to treatment

  At Paley European Institute, we take an individual approach to each patient. We assess whether the deformity is physiological or pathological and whether it affects the child's quality of life. We pay great attention to the degree of flexibility of the foot and the presence of pain symptoms. Our team of specialists (pediatric orthopedists, physiotherapists and orthopedic technicians) work interdisciplinarily, selecting the best treatment path - from conservative therapy to modern surgical methods.

•  Treatment Methods

  Conservative treatment:
  - Physiotherapy - strengthening the short muscles of the foot, exercises to improve foot alignment and postural control.
  - Individual orthotic insoles - used for symptomatic flexible flat foot.
  - Orthopedic footwear - individually selected to support proper foot alignment.
  
  Surgical treatment (in case of no improvement or stiff/painful deformity):
  - Arthroerezis - minimally invasive surgery to insert implants into the popliteal space to stabilize the hindfoot.
  - Corrective osteotomies of the heel bone or wedge bone - for more advanced cases.
  - Treatment of tarsal bone coalitions - if a rigid flat-foot is found with an osseous cause

• Post-operative care

  After the operation, the child remains under the constant supervision of the orthopedic and physiotherapy team. The rehabilitation process includes:
  - immobilization in a plaster dressing or orthosis
  - gradual mobilization of the limb with an individualized physiotherapy plan,
  - regular x-ray and clinical checks,
  - support of the PEI therapy team in returning to full activity.

• Treatment results
  In cases of flexible flat foot, conservative treatment usually has very good results and avoids surgical intervention. In patients who undergo surgery, especially after arthrodesis, there is a significant improvement in the alignment of the foot, a reduction in pain and an improvement in quality of life. Proper post-operative care and rehabilitation allow children to return to full physical activity, including sports.

Hollow Foot

• Description of the disease

  Hollow foot (pes cavus) is a deformity in which the longitudinal arch of the foot is excessively arched. This means that the weight of the body is not distributed evenly - most of the load is taken up by the heel and forefoot. It can occur as unilateral or bilateral and often coexists with other deformities: clawed toes, forefoot adduction, excessive supination or ankle instability. In many patients, the hollow foot has a neurological basis (e.g., Charcot-Marie-Tooth disease), but it can also be idiopathic (with no known cause) or post-traumatic.

• Diagnostics

  Diagnosis of hollow foot includes:
  - A thorough history - questions about the presence of pain, difficulty walking, frequency of stumbling, family history of neurological disease.
  - Physical examination - evaluation of longitudinal arch, heel alignment, joint mobility, presence of hammer toes or clawed toes.
  - Coleman block test - helps assess whether the deformity is flexible or rigid.
  - Imaging studies - X-ray of the feet in standing projections allows assessment of the Meary angle, forefoot and heel angles.
  - Neurological consultation and EMG/NCS testing - in cases of suspected neuromuscular disease.

• Our approach to treatment

  At PEI, we always try to approach each case individually. We analyze in detail the etiology of the deformity, the severity of the deformity and the patient's functional needs. We work with the neurological and rehabilitation team to develop the most comprehensive treatment plan - whether conservative or surgical management is required. Early detection of any progressive neuromuscular disease is also crucial.

• TreatmentmethodsConservativetreatment:
  - Individually fitted orthotic insoles to support proper foot alignment.
  - Physiotherapy - strengthening the muscles of the foot and ankle joint, improving balance.
  - Stabilizing shoes with proper correction.
  Surgical treatment (for rigid or progressive deformities):
  - Forefoot correction - osteotomy of the first metatarsal bone (e.g., Cole method, Japas method).
  - Heel osteotomy (e.g., Dwyer) - correction of heel bone alignment.
  - Tendon transfers - e.g., transfer of the tendon of the posterior tibial m. or the long fibula.
  - In severe cases - arthrodesis of selected tarsal joints.
  The procedure is always planned with a view to preserving maximum mobility of the foot and minimizing the risk of recurrence of the deformity.

•  Post-operative care

  After surgery, the patient goes through several stages:
  - Immobilization and weight-bearing for 6-8 weeks (cast or orthosis).
  - Gradual weight-bearing and rehabilitation, including range-of-motion exercises, strengthening, learning to walk.
  - Regular orthopedic and physiotherapeutic checks to monitor healing and biomechanical adaptation.
  - Dynamic orthotics or orthoses may be used to support the effect of surgery.

• Treatment results

  With well-planned treatment and cooperation between the patient and the medical team, the results are very good. Patients regain gait stability, pain is reduced, and the risk of injury (such as sprains) decreases. In neurological cases, it is possible for the deformity to return, so it is important to have regular check-ups and adjust treatment according to the course of the underlying disease. In idiopathic or post-traumatic cases - we achieve a very permanent correction and improvement in quality of life.

Forefoot Adducted

• Description of the condition
  Adducted metatarsus (Latin: metatarsus adductus) is a foot deformity in which the forefoot - that is, the part of the foot from the metatarsal to the toes - is directed inward relative to the rearfoot. Most often, it is a congenital defect, visible after birth. There are different degrees of severity - from a flexible, easily corrected, to a rigid, more fixed form. The condition usually occurs bilaterally and more often in boys.Adducted forefoot can be an isolated defect or coexist with other deformities, such as clubfoot or developmental dysplasia. The abnormality is usually due to limited space in the uterus during the third trimester of pregnancy, which causes the forefoot to mechanically bend inward.
•  Diagnosis
  The diagnosis of adducted forefoot is based mainly on physical examination. The doctor evaluates the shape of the foot at rest and the flexibility of the forefoot when attempting to visit it. It is crucial to differentiate with other deformities, such as clubfoot or radial foot.
  In some cases, especially when a rigid form or concomitant defects are suspected, imaging studies are performed - primarily foot X-rays in AP (anteroposterior) projection, usually after the age of 6 months, when the foot begins to ossify. In younger children, ultrasound may be helpful.
• Our approach to treatment
  At Paley European Institute, we take an individualized approach to each patient, assessing the severity of the deformity, the child's age and the presence of any coexisting defects. We strive for the least invasive treatment possible, starting with conservative methods and observation, and only in refractory cases do we reach for orthopedic or surgical treatment.
• 4 Treatment methods
  In the case of flexible adducted forefoot, daily stretching exercises conducted by parents or a physiotherapist are often sufficient. Appropriate carrying and positioning positions for the child are also recommended (for example, avoiding sitting in a "W").
  If the deformity is not self-correcting or is more advanced, plaster treatment is applied using the Ponseti serial dressing method - similar to the treatment of clubfoot. In severe, stiff cases, surgical treatment is possible - such as tendon grafts or osteotomy of the metatarsal bones (e.g., Lapidus osteotomy or McBride osteotomy).
• 5 Postoperative care
  After surgery, the patient requires immobilization of the limb in a plaster dressing for several weeks, and then the start of rehabilitation. Exercises to improve range of motion, strengthen muscles and re-educate the gait pattern are key. The child remains under regular orthopedic follow-up to monitor further development of the foot.
• 6 Treatment results
  The prognosis in adducted forefoot is very good, especially when the deformity is flexible and diagnosed early. Most cases do not require surgical intervention and resolve spontaneously or after conservative treatment. Even with more advanced forms, the use of appropriate correction techniques yields very good functional and aesthetic results, allowing the child to develop properly and be physically active without restrictions.

The Bone Tarsus Coalition

• Description of the disease

  A tarsal coalition is a congenital fusion of two or more tarsal bones that should normally be separate. It can take the form of a bony, cartilaginous or fibrous joint. The most common connection is between the calcaneus and the calcaneus (coalitio calcaneonavicularis) or the calcaneus and the ankle (coalitio talocalcanea). The condition can lead to reduced mobility of the foot, chronic pain and recurrent sprains. Symptoms usually begin in late childhood or adolescence, when the bones ossify and become less flexible.

• Diagnostics

  Diagnosis of tarsal bone coalition is based on a detailed history and physical examination - restriction of mobility in the subtalar joint and pain when attempting to pronate or supinate the foot are often present.

  The gold standard is imaging studies:
  - X-ray in special projections (e.g., oblique projection of the foot) can show bony connections.
  - Computed tomography (CT) - the best method for detecting bony coalitions.
  - Magnetic resonance imaging (MRI) - especially useful for diagnosing cartilaginous and fibrous coalitions and for assessing inflammation in surrounding tissues.

• Our treatment approach
  At PEI, we tailor treatment of tarsal bone coalitions individually according to the degree of deformity, the location of the coalition and the patient's clinical symptoms. We carefully analyze imaging and conduct a thorough evaluation of the biomechanics of the foot. In patients with minor complaints, we start with conservative treatment. In more advanced or refractory cases, we qualify for surgical treatment - always considering the least invasive methods possible and long-term results.

• Treatment methods

  Conservative treatment:
  - immobilization of the foot (orthosis, cast),
  - painkillers and anti-inflammatory drugs,
  - physiotherapy and manual therapy,
  - individual orthotics.

  Surgical treatment:
  - Coalition resection - removal of a bony or cartilaginous joint, often with interposition of tissue (such as fat) to prevent recurrence.
  - Arthrodesis (joint stiffening) - in advanced cases, when joints are already significantly damaged or secondary degenerative changes are present.

•  Post-operative care

  After surgery, the patient usually requires immobilization of the limb in a brace or plaster dressing for several weeks. We introduce gradual weight bearing on the limb and implement an individually tailored physiotherapy program. Our therapists guide the patient through the entire rehabilitation process - from range-of-motion exercises, to muscle strength restoration, to gait re-education and proprioception training.

•  Treatment results

  Early diagnosis and appropriately selected treatment of tarsal bone coalitions yields very good results. Resection of the coalition in younger patients often results in complete resolution of symptoms and full return to activity. In advanced cases, arthrodesis provides stabilization of the foot and abolition of pain, although it involves some limitation of mobility. Our experience shows that a comprehensive approach - from diagnosis to rehabilitation - significantly improves patients' comfort and minimizes the risk of recurrence.

The hallux valgus toe

• Description of the disease

  Hallux valgus is a forefoot deformity in which the first toe deviates laterally (toward the second toe) and the first metatarsal bone points medially. This results in the formation of a characteristic "bump" at the base of the toe, which can cause pain, inflammation, difficulty in shoe selection and limitations in daily function. This deformity can be genetic, biomechanical, the result of wearing inappropriate footwear or coexist with other foot conditions, such as transverse flatfoot

• Diagnostics

  Diagnosis of hallux valgus toe is based on:
  - Medical history - determining the severity of pain, functional limitations and patient expectations.
  - Physical examination - assessment of toe alignment, joint mobility and soft tissue tension.
  - X-ray of the feet under load - a key examination to assess the degree of deformity (the angles between the metatarsal bones and the phalanx of the toes), the presence of degenerative changes and any concomitant deformities (e.g., hammer toes, metatarsalgia).

• Our approach to treatment

  At Paley European Institute, we emphasize:
  - Selecting the treatment method individually according to the degree of deformity, age, activity and expectations of the patient.
  - In cases of moderate deformity - we prefer minimally invasive techniques, which are associated with less tissue trauma, shorter recovery and better aesthetic results.
  - Each case is discussed as a team, involving an orthopedic surgeon, a physical therapist and, if necessary, a pain management specialist.

•  Treatment methods

  Minimally invasive percutaneous surgery of the hallux valgus toe
  This is a modern technique that involves performing the procedure through very small skin incisions (about 2-5 mm), using specialized instruments and intraoperative X-ray (C-arm) inspection.

  Among the most commonly used techniques are:
  - Percutaneous Chevron osteotomy (MICA - Minimally Invasive Chevron-Akin) - allows correction of the axis of the metatarsal bone and proximal phalanx of the toe.
  - Modifications of Reverdin and Akin techniques - used depending on the characteristics of the deformity.
  - Stabilization with micro-implants or screwless (in selected cases).

  Advantages of the method:
  - Minimal scarring and surgical trauma,
  - Shorter surgery and hospitalization time,
  - Faster return to activity,
  - Lower risk of wound healing complications.

•  Post-operative care

  After the surgery, the patient:
  - Can move around in a special pressure relieving shoe (e.g. Baruka) from the first day after surgery.
  - Does not require immobilization with a cast.
  - Return to full weight-bearing of the foot usually takes 4-6 weeks.
  - Individual physiotherapy aimed at restoring range of motion, strength and normal gait pattern is conducted.
  - Radiological checks are performed in the following weeks to monitor the process of fusion and correction.

• Treatment results

  Minimally invasive treatment of the hallux valgus toe produces very good functional and aesthetic results:
  - More than 90% of patients achieve significant improvements in walking comfort and the appearance of the foot.
  - Low rate of complications - infection, fusion disorders or recurrence.
  - Ability to correct simultaneous forefoot deformities (e.g., hammer toes) during a single procedure.
  - High level of patient satisfaction with the cosmetic effect and speed of return to activity.

• Bone healing disorders are a group of conditions that affect the process of bone repair after trauma, surgery or infection. Correct identification of the cause and implementation of appropriate treatment is key to achieving a full recovery.

Amputation care requires a comprehensive and multidisciplinary approach that includes both medical and psychological aspects. Our team of specialists provides full support at every stage of the rehabilitation process, from pre-operative preparation to surgery and long-term post-operative care.

Targeted Muscle Reinnervation (TMR) of the amputation stump

• Description of the disease

  Targeted Muscle Reinnervation (TMR) is an advanced surgical technique used to treat neuropathic pain and phantom pain, which often occur after limb amputation. The procedure involves relocating nerves that have lost their original destination to adjacent muscles that have been rendered functionless after amputation. As a result, the nerves find new endings, which reduces pain, improves the patient's quality of life and enables better use of myoelectric prostheses through better control.

• Diagnostics

  Patients referred for TMR usually suffer from chronic phantom pain, neuropathic pain or recurrent stump neuropathy after amputation. Diagnosis includes a detailed medical history, clinical evaluation and additional tests such as electromyography (EMG), peripheral nerve ultrasound and sometimes magnetic resonance imaging (MRI) to accurately assess the condition of the nerves and determine the optimal site of nerve reinsertion into the muscles.

•  Our approach to treatment

  In our approach to treating patients with phantom or neuropathic pain after amputation, we place great emphasis on a comprehensive, interdisciplinary approach. We discuss each case in detail during consiliums involving orthopedists, surgeons, neurologists, physiotherapists and prosthetic specialists. We strive to individually tailor the TMR procedure to the needs of each patient, aiming not only to eliminate pain, but also to maximize the restoration of stump function and improve integration with the prosthesis.

• Treatment Methods

  The TMR procedure involves surgically rerouting the nerve endings of the amputated limb to nearby target muscles that had previously lost function due to amputation. The surgical intervention is performed in an operating room setting under a surgical microscope or magnifying glass to ensure the precision of the procedure. Once the nerves are rerouted to the muscles, the nerve endings find new neuromuscular connections, which contributes to a significant reduction in phantom pain and enables easier control of the myoelectric prosthesis.

• Post-operative care

  Post-operative care includes comprehensive rehabilitation, which begins in the first days after surgery. Physiotherapists, together with doctors, oversee the healing of the wound and the gradual strengthening of the muscles to which the nerves have been rerouted. Rehabilitation includes muscle control training, learning to use the myoelectric prosthesis, and pain therapy tailored to the patient's individual needs. Progress is monitored regularly, and the patient is in constant contact with specialists.

• Treatment results

  The results of treatment with targeted muscle reinnervation are promising, with the vast majority of patients reporting significant reductions in phantom and neuropathic pain just a few months after surgery. With improved muscle control, patients use modern myoelectric prostheses more effectively, leading to improved quality of life, increased activity and better self-esteem. Regular care and rehabilitation allow patients to quickly return to social, occupational and recreational activities.

Regenerative Peripheral Nerve Interface (RPNI)

• Description of the disease

  RPNI (Regenerative Peripheral Nerve Interface), or Regenerative Peripheral Nerve Interface, is an innovative surgical method used to treat painful neuromas that form within the stump after limb amputation. These neuromas occur when an interrupted peripheral nerve chaotically regenerates to form painful nodules, causing chronic pain, discomfort, hypersensitivity of the stump and difficulty fitting a prosthesis. The RPNI procedure involves guiding nerve regeneration in a controlled manner by fusing the nerve ending to a piece of muscle tissue, which prevents uncontrolled growth of the neuroma and enables patients to improve their quality of life after amputation.

• Diagnostics

  Diagnosis of stump neuroblastoma after amputation is based primarily on a detailed history and physical examination, during which the patient reports local pain, hypersensitivity or characteristic neurological complaints associated with the neuroblastoma. In addition, imaging studies such as ultrasonography (ultrasound), magnetic resonance imaging (MRI) are performed to determine the precise location and size of the pathological neuroblastoma. EMG (electromyography) testing can also be helpful in assessing nerve conduction.

• Our approach to treatment

  Our priority is to effectively treat pain and significantly improve the quality of life of patients struggling with stump neuroma after amputation. We use a multidisciplinary approach, combining orthopedic, neurological and surgical expertise, selecting an individualized treatment plan. We prefer to use the RPNI method as a modern and effective solution for patients who have not improved after conservative treatment or classic surgical procedures.

• Treatment methods

  The primary method of treatment is the RPNI procedure. It involves surgically isolating the nerve ending and implanting it into a piece of muscle taken from the patient. This allows the nerve to penetrate the muscle during regeneration, forming a biological connection with it, preventing uncontrolled growth of the neuroma and reducing pain. Alternative methods that can be used before opting for RPNI are techniques such as classic resection of the neuroblastoma, neurolysis, or the TMR (Targeted Muscle Reinnervation) technique.

• Post-operative care

  After RPNI surgery, the patient receives comprehensive care, including pain control, regular follow-up visits, and cooperation with a rehabilitation specialist and prosthetist. It is important to devote the early postoperative period to protecting the operated area, controlling pain and gradually introducing physiotherapy aimed at recovery, adaptation of the stump to the prosthesis and prevention of secondary complications (contractures, adhesions).

Osseintegration

• Description of the disease
  

  Osseointegration of the amputation stump is a modern treatment method that involves permanently connecting a metal implant to the stump bone. This technique allows the prosthetic limb to anchor directly to the patient's bone, providing greater stability, comfort and improved quality of life compared to traditional skin-mounted prostheses. Osseointegration is particularly beneficial for patients whose silicone funnel prosthesis causes discomfort, skin abrasion or mobility problems.

• Diagnostics

  Prior to osseointegration surgery, accurate diagnostic imaging is crucial. We use computed tomography (CT), magnetic resonance imaging (MRI) and X-rays to assess the quality and quantity of bone tissue in the stump. In addition, it is important to assess the condition of the skin, soft tissues and rule out infection. We also verify the patient's general health to make sure there are no health contraindications, such as diabetes or vascular disease.

• Our approach to treatment
  

  At our center, we focus on a comprehensive approach to the patient, which includes both surgical treatment and comprehensive rehabilitation and psychological support. Each case is considered individually, taking into account the patient's age, amputation level, expectations and functional capabilities. We make every effort to make the osseointegration process safe, comfortable and effective.

• Treatment Methods
  

  The osseointegration procedure is usually performed in two stages. In the first stage, an implant made of titanium is implanted directly into the stump bone. This is followed by several months of healing, during which the implant is permanently fused to the bone tissue (osseointegration). In the second stage, after healing, a special abutment (abutment) is brought outside the body to attach the prosthesis. This process allows a stable, permanent and secure connection of the prosthesis to the patient's bone.

• Post-operative care
  

  Post-operative care is a key element in the success of treatment. The patient remains under close supervision of our orthopedic team. Appropriate pain relief and antibiotic therapy are used in the initial period to minimize the risk of infection. Very important is rehabilitation, which begins soon after surgery and lasts several months. Its goal is to gradually load the limb, adapt to the new way of fixing the prosthesis and rebuild muscle strength.

• Treatment results
  

  Osseointegration gives patients significantly better functional results compared to traditional prosthesis fixation methods. Most patients experience a significant reduction in pain, improved stability and greater freedom of movement. In addition, the elimination of skin problems, which often accompany classic denture fixation methods, significantly improves the comfort of life. Thanks to osseointegration, patients can return to many physical activities, which has a positive impact on both physical and mental health.

Stump plastic surgery

• Description of the disease

  Stump plastic surgery is a specialized orthopedic procedure that aims to improve the functionality, aesthetics and comfort of life for patients with limb amputations. After amputation, problems such as phantom pains, chronic pain, wounds that are difficult to heal, infections or prosthetic problems resulting from an abnormal shape of the stump can arise. Stump plastic surgery aims to correct these complications by properly modeling the soft tissues, skin, muscles and skeletal system to achieve the best possible quality of the stump for continued use of the prosthesis.

• Diagnostics

  Diagnosis before stump plastic surgery includes a detailed medical history and physical examination of the stump, assessment of the blood supply and innervation of the limb, as well as the condition of the soft tissues and scars. An important part of the diagnosis is the performance of imaging studies, such as X-ray, magnetic resonance imaging (MRI) or computed tomography (CT), which allow assessment of the condition of the bone and the presence of any pathological changes. Depending on the situation, consultations with specialists such as a neurologist, vascular surgeon or physical therapist may be needed.

• Our approach to treatment

  At our center, the treatment of patients requiring stump plasty is carried out comprehensively, taking into account the individual needs of the patient. We pay special attention to proper preoperative preparation, which includes pain control, treatment of infection and optimization of the patient's systemic conditions. We use advanced surgical techniques to achieve optimal shape and functionality of the stump, which directly affects the patient's quality of life after surgery.

• Treatment methods

  Plastic surgery on the stump can involve a variety of techniques, depending on the patient's specific problems:
  - Skin and soft tissue correction: removing excess skin, reducing scarring, and shaping the shape of the stump to provide a better fitting prosthesis.
  - Bone revision: correction of unevenness, sharpness or other bone abnormalities that can cause pain and make prosthetics difficult to fit.
  - Peripheral nerve plication (neuroma): treatment of painful neuromas by surgically removing them and properly placing nerve endings in the muscles to minimize the risk of recurrent phantom pain.
  - Muscle reconstruction techniques (myoplasty/myodesis): techniques to achieve better muscle stabilization, which improves the functionality and comfort of the prosthesis.

• Post-operative care

  Post-operative care includes appropriate pain management and care of the surgical wound, control of blood supply and skin condition, and use of elastic compression. Special emphasis is placed on early rehabilitation, which begins in the first days after surgery. This process includes appropriate exercises, mobilization and gradual habituation of the stump to the prosthesis. We work closely with prosthetists to fit a suitable prosthesis as soon as possible, enabling the patient to return to activity.

• Treatment results

  Using modern surgical techniques and a comprehensive therapeutic approach, we achieve very good treatment results. Patients report a significant reduction in pain, an improvement in the comfort of their prostheses and a significant improvement in their quality of life. Most operated patients return to full life and work activities within a short time after surgery. Regular check-ups allow us to evaluate the effects of treatment and make any adjustments, guaranteeing long-lasting and satisfying results.

Stump lengthening

• Description of the disease

  Stump lengthening after amputation is a specialized orthopedic procedure used for patients whose existing lower or upper limb stump is too short to provide adequate prosthesis or full function. An inadequate stump length can cause difficulty in fitting a prosthesis, pain, movement limitations and significantly reduce the patient's comfort.

• Diagnostics

  Before deciding on treatment, it is necessary to perform precise diagnostics. X-rays (X-rays) of the stump are a standard part of the diagnostics, which allow assessment of the quality of the bone tissue and any pathological changes. Additional tests such as computed tomography (CT) or magnetic resonance imaging (MRI) are also important, especially if soft tissue pathology is suspected. In addition, a detailed clinical evaluation is performed, taking into account range of motion, muscle strength and soft tissue status.

• Our approach to treatment

  Our approach to treatment is based on close cooperation between a team of orthopedic specialists, physiotherapists and prosthetists. We precede each treatment with a thorough analysis of the individual case, setting realistic treatment goals together with the patient. We take care of comprehensive care, from the planning stage of surgery to full post-operative rehabilitation and the achievement of maximum possible functionality of the limb.

• Treatment methods

  The most common method of treating stump lengthening is osteogenesis distraction, which involves controlled cutting of the bone and its gradual lengthening using external devices (e.g. Ilizarov apparatus or Orthofix splint systems). In justified cases, we also use modern solutions in the form of internal lengthening using magnetic nails or telescopic internal implants (e.g. PRECICE). The choice of method is determined by the location of the amputation, the condition of the stump and the individual needs of the patient.

• Post-operative care

  After surgery, the patient remains under the constant care of a team of specialists. Properly conducted rehabilitation, which begins just a few days after surgery, is crucial. Under the supervision of a physiotherapist, exercises are carried out to strengthen muscles, improve joint range of motion and proprioception exercises. We regularly monitor the progress of healing and make any necessary adjustments to the positioning of the extension apparatus. It is also very important to educate the patient on the care of the stump and the use of the prosthesis.

• Treatment results

  The results of amputation stump lengthening treatment are usually very good, provided the patient and the treatment team work closely together. Most patients achieve a significant improvement in quality of life, improved functionality of the stump and much better adaptation to the prosthesis. Treatment also reduces pain, increases the range of physical activity and significantly improves the comfort of daily functioning.

Selection and fitting of prosthesis.

•  Description of the problem

  Amputation of a limb, regardless of the cause (trauma, vascular disease, cancer or congenital defects), is a huge change in a patient's life. The introduction of a prosthesis is a key step in the rehabilitation process to regain functionality, independence and improve quality of life. The selection and fitting of a prosthesis is a complex process that requires an individual approach, taking into account both the physical and psychological aspects of the patient.

•  Diagnostics

  The process of fitting the prosthesis begins with a thorough clinical evaluation of the patient:

• Evaluation of the stump - its length, shape, skin condition, healing of the surgical wound and the presence of scarring or hypersensitivity.

  Assessment of general health - cardiovascular and respiratory condition, co-morbidities.
  Assessment of physical fitness and activity level - to select the appropriate type of prosthesis.
  Psychological assessment - the patient's readiness for prosthesis and adaptation to the new situation.
  In some cases, additional imaging studies (e.g., X-ray of the stump) and specialist consultations (e.g., neurologist, physiotherapist) are performed.

• Our approach to treatment

  At Paley European Institute, we take a team-based and comprehensive approach to the prosthetic process. Our patients are cared for by an interdisciplinary team: orthopedic surgeons, physical therapists, psychologists and prosthetists. We focus on preparing the patient physically and emotionally for the use of the prosthesis and provide support at every stage, from consultation to long-term care.

•  Treatment methods

  The process of fitting a prosthesis takes place in several stages:

• Stump preparation: compression dressings, scar mobilization, learning how to care for the stump.

  Temporary prosthesis: used at the stage of learning to walk and shaping the stump.
  Proper selection of the prosthesis: taking into account the level of amputation (e.g. below-knee, above-knee, upper limb amputations), the patient's activities and life goals.
  Individualized fit: the prosthesis is modeled and adjusted to the patient's needs.
  Rehabilitation: learning to use the prosthesis, practicing balance, coordination, gait.
  Psychological care: support in the process of adaptation and confidence building.

•  Post-operative care

  After the prosthesis, the patient is included in a follow-up and rehabilitation program. Regular visits allow monitoring the condition of the stump, adjusting the prosthesis to changing needs (e.g., weight changes) and detecting possible problems - such as corns, irritation or mechanical damage. Patient education on prosthesis maintenance and stump self-care is also crucial.

•  Treatment results

  An effectively selected and fitted prosthesis allows patients to return to daily activities, work, sports and even extreme activities. Many amputee patients function completely independently, and the prosthesis becomes an integral part of their lives. With proper rehabilitation and support, a high level of physical and mental fitness can be achieved

• Treatment results

  The results of the RPNI method are very promising, with most patients reporting a significant reduction in pain, improved comfort in wearing the prosthesis and increased functionality of the stump. Patients return to physical activity faster and improve their quality of life. In addition, the method significantly reduces the risk of recurrence of a painful neuroma compared to traditional treatment methods.

Osteoarthritis (arthritis) is a progressive degenerative process that leads to damage to joint cartilage and surrounding tissues. It is one of the most common diseases of the musculoskeletal system, affecting millions of people worldwide, especially in the elderly population.

Disruption of the mechanical axis of the lower limbs

• Description of the disease

  Lower limb axis disorders are a group of deformities characterized by abnormal alignment of the legs with respect to the mechanical axis of the body. Among the most common are valgus ("X" leg alignment) and hallux valgus ("O" leg alignment). They can be physiological in children of a certain developmental age or pathological, resulting from congenital defects, trauma, metabolic diseases (such as rickets), neurological diseases or bone dysplasias. Disorders of lower limb alignment cause uneven joint loading, leading to pain, faster wear of joint cartilage and serious functional problems in later life.

• Diagnostics

  Diagnosis of lower extremity alignment disorders begins with a detailed physical examination and visual assessment of the patient in the standing position and during gait. We use specialized clinical measurements, such as assessing the angle between the thigh and shin, the intercostal or inter-knee distance. Imaging studies are crucial, especially X-rays of the entire lower extremities while standing, which allow precise measurement of deformity angles (mechanical angle of the limb axis, MAD - mechanical axis of the limb). In case of suspected comorbidities, we additionally perform magnetic resonance imaging (MRI) or computed tomography (CT).

• Our approach to treatment

  Our primary goal in the treatment of lower limb alignment disorders is to restore the normal mechanical axis of the limb, which allows us to normalize joint loading, improve living comfort and prevent long-term complications. We individualize treatment depending on the age of the patient, the severity of the deformity and potential comorbidities. We choose the least invasive methods that provide the best cosmetic and functional results.

• Treatment methods

  In children with mild, physiological axis disorders, we often use observational management, physiotherapy and appropriate physical activity. For pathological deformities or severe limb axis abnormalities, we recommend surgical treatment, such as corrective osteotomies, performed with modern techniques, using special plates or correction with external braces. After our surgeries, the patient immediately weights the next day after the operation. We choose the type of surgery individually according to the clinical situation.

• Post-operative care

  After lower limb axis correction procedures, properly managed postoperative care is crucial. In the first stage, it is important to avoid loading the operated limb (depending on the surgeon's recommendations), use immobilization or orthoses, regular radiological and clinical checks. Then we implement intensive rehabilitation with a physiotherapist, including muscle strengthening, improving range of motion, gait training and re-education of movement patterns. During this period, the cooperation of the patient, family and specialists is particularly important.

• Treatment results

  The results of treatment of lower limb axis disorders are usually very good, especially with early diagnosis and an appropriately selected treatment method. Most patients regain full functional capacity and an aesthetically normal appearance of the lower extremities. Limb axis correction allows a significant improvement in quality of life, eliminates pain and significantly reduces the risk of early degenerative joint changes. Long-term follow-up of patients confirms the effectiveness of the treatment methods used.

Osteoarthritis of the knee joint

• Description of the disease

  Osteoarthritis of the knee (gonarthrosis) is a chronic condition involving progressive damage to the articular cartilage, subchondral bone and surrounding soft tissues. It most often affects people over the age of 50, but can also occur earlier, especially in people who are physically active, post-injury, overweight or genetically predisposed. It manifests as pain, limited mobility, crackling and swelling of the joint, which significantly limits patients' daily functioning.

• Diagnostics

  The diagnosis of osteoarthritis of the knee is based on a detailed medical history, clinical examination and diagnostic imaging. The standard examination is an X-ray of the knee in AP and lateral projections, on which the characteristic narrowing of the joint crevice, osteophytes (bony outgrowths) and thickening of the subchondral bone are visible. In addition, magnetic resonance imaging (MRI) is used, especially if soft tissue injuries such as ligaments or meniscus are suspected.

• Our approach to treatment

  In our approach, individualization of treatment is a priority. We treat each patient comprehensively, adapting treatment methods to the severity of degenerative changes, age, lifestyle and patient expectations. We focus primarily on alleviating pain symptoms, improving joint function and maintaining full function for as long as possible. Treatment is graded - from conservative methods to advanced surgery.

• Treatment methods

  We treat the initial stages of the disease with conservative methods, which include pharmacotherapy (painkillers and anti-inflammatory drugs), physiotherapy, kinesitherapy, as well as delivery injections of preparations such as hyaluronic acid or platelet-rich plasma (PRP). In advanced stages, we use surgical treatment: knee arthroscopy (clearing the joint), corrective osteotomies in patients with limb axis deformities, and knee endoprosthesis (partial or total joint replacement).

• Post-operative care

  Postoperative care is crucial for optimal surgical results. Immediately after surgery, the patient undergoes comprehensive rehabilitation, including appropriately selected physical therapy, physical therapy and learning to walk using orthopedic aids. We carefully monitor the course of healing, taking care to control pain and prevent complications such as infection, thrombosis or stiffness of the joint.

• Treatment results

  Properly selected treatment, especially in the case of surgical procedures, allows for a significant reduction in pain and an improvement in the patient's performance and comfort. Most people recover fully or almost fully in their daily activities after knee endoprosthesis. Regular rehabilitation and adherence to the doctor's recommendations make it possible to achieve lasting treatment results, and the effects of therapy last for many years.

Osteoarthritis of the hip joint

• Description of the disease

  Osteoarthritis of the hip (coxarthrosis) is a chronic condition involving the gradual destruction of joint cartilage and secondary damage to bone and periarticular structures. As the disease progresses, there is reduced joint mobility, increasing pain, stiffness, and in advanced stages, significant difficulties in daily functioning. It is most common in the elderly, but can also occur in younger patients, such as as a result of trauma, congenital defects or systemic diseases.

• Diagnostics

  The diagnosis of coxarthrosis is based on a detailed medical history, physical examination and imaging studies. The primary examination is an x-ray (X-ray), which shows joint stenosis, the presence of osteophytes, subchondral cysts and sclerotic changes. Additionally, in more complex cases, a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be performed to accurately assess the condition of the soft tissues around the joint and the extent of the disease.

• Our approach to treatment

  Our approach to treating coxarthrosis is individual and comprehensive. The most important thing is to tailor therapy to the severity of the disease, the patient's expectations and his overall health. Initially, we try to use conservative treatment methods to slow the progression of the disease, reduce pain and improve the patient's quality of life. In advanced stages of the disease, we usually offer surgical treatment.

•  Treatment methods

  In conservative treatment, we use pharmacological agents (analgesics, non-steroidal anti-inflammatory drugs), physiotherapy, rehabilitation exercises and supportive treatments such as delivery injections (hyaluronic acid, platelet-rich plasma PRP). When conservative treatment is no longer effective, we offer surgical treatment. The most commonly performed procedure is hip endoprosthesis, which is the replacement of the damaged joint with an artificial prosthesis. This procedure significantly improves the comfort of life, reduces pain and restores the functionality of the limb.

• Post-operative care

  Post-operative care is crucial to the success of the procedure. The patient remains under the supervision of a team of specialists, including an orthopedic surgeon, a physiotherapist and nurses. On the very first day after surgery, rehabilitation is started with the goal of getting the patient up and running quickly, learning to walk with crutches and improving mobility in the operated joint. Antithrombotic prophylaxis, pain management and patient education on daily activities and lifestyle after surgery are also important aspects of postoperative care.

• Treatment results

  The results of treatment for osteoarthritis of the hip are very good, especially after joint replacement surgery with an endoprosthesis. In the majority of patients, we achieve a significant reduction in pain, improvement in mobility and restoration of the ability to perform daily activities. About 90% of patients report high satisfaction with the results of surgery. The final results of treatment depend on appropriate rehabilitation management, adherence to medical recommendations and the patient's lifestyle.

Osteoarthritis of the ankle joint

•  Description of the disease

  Osteoarthritis is a chronic condition involving gradual wear and tear of the articular cartilage and secondary changes in the bony structures. This results in pain, limited range of motion and functional disorders that negatively affect patients' comfort. The causes of degeneration can be previous trauma (fractures, dislocations), chronic instability of the joint, rheumatic diseases, mechanical overload, as well as congenital defects.

•  Diagnostics

  Diagnosis of osteoarthritis of the ankle joint begins with a detailed medical history and clinical examination. The doctor assesses the range of motion of the joint, the presence of pain, swelling and deformity. This is followed by imaging studies - the standard is an X-ray of the ankle joint in anteroposterior and lateral projections. In infected or questionable cases, the diagnosis is expanded to include magnetic resonance imaging (MRI) or computed tomography (CT), which allows a more accurate assessment of cartilage, ligaments and bony structures.

•  Our approach to treatment

  At our center, we take an individual approach to each patient with osteoarthritis of the ankle joint. We begin treatment with conservative methods, focusing on alleviating pain and improving the function of the joint. In advanced cases, where conservative methods prove insufficient, we offer patients surgical treatment, selecting a technique appropriate to the severity of the lesions and the patient's expectations for motor activity after surgery.

• Treatment Methods

  Conservative treatment includes pharmacotherapy (painkillers and anti-inflammatory drugs), physical rehabilitation, physical therapy and orthopedic supplies (orthoses, orthotics). In advanced cases, we offer surgical treatment. Surgical methods include:
  Arthroscopic joint debridement (removal of altered tissues, damaged cartilage fragments).
  Corrective osteotomies, correcting the mechanical axis of the lower limb in cases of malalignment of the joint.
  Arthrodesis (stiffening) of the ankle joint - a procedure that effectively eliminates pain, although at the expense of partial loss of joint mobility.
  Ankle joint endoprosthesis - involving the implantation of an artificial prosthesis, which preserves the mobility of the joint and improves the patient's comfort.

•  Post-operative care

  After the surgery, the patient remains under constant supervision of our medical team. Pain relief and anti-edema treatment is implemented immediately after surgery. Early rehabilitation is key to achieving good results - the patient follows an individualized exercise plan under the supervision of a physiotherapist, gradually restoring mobility, muscle strength and normal gait pattern. Patients are also advised to use elbow crutches or special orthoses to relieve pressure on the operated limb for a limited period of time.

• Treatment results

  The results of treatment of osteoarthritis of the ankle at our center are very good, as confirmed by both follow-up studies and patient feedback. Thanks to the precise selection of treatment methods and comprehensive rehabilitation care, patients achieve significant pain reduction, functional improvement and return to daily activities. Surgical procedures, especially arthrodesis and endoprosthesis, have a high patient satisfaction rate, significantly improving their quality of life.

Osteoarthritis of the shoulder joint

• Description of the disease
  Osteoarthritis of the shoulder joint is a chronic condition characterized by the progressive destruction of joint cartilage. This leads to pain, reduced mobility and a gradual decrease in the efficiency of the upper limb. It is most common in the elderly, although it can also affect younger people following trauma, chronic inflammation or as a result of occupational or sports overload. Typical symptoms are pain that worsens with movement, morning stiffness and limitation of range of motion.

• Diagnostics

  The basis of diagnosis is a detailed medical history and clinical examination of the patient. The next step is to perform imaging examinations, primarily X-rays, which highlight typical degenerative changes: joint stenosis, osteophytes (bone outgrowths), subchondral sclerosis and cysts. When warranted, we also perform magnetic resonance imaging (MRI) or computed tomography (CT) scans to more precisely assess the condition of the soft structures and the extent of damage to the shoulder joint.

• Our approach to treatment

  Our approach to treating osteoarthritis of the shoulder is based on a comprehensive assessment of the patient's condition, taking into account the severity of the lesions and the individual needs of the patient. We aim to reduce pain, improve mobility and restore shoulder function using modern, minimally invasive treatment methods and appropriately tailored rehabilitation.

• Treatment methods

  Treatment can include both conservative and surgical methods. Initially, we offer non-surgical treatment, including anti-inflammatory drugs, physiotherapy, kinesitherapy, manual therapy and delivery injections (such as hyaluronic acid or platelet-rich plasma - PRP). When conservative treatment proves insufficient and degenerative changes are advanced, we perform surgical treatment. We prefer minimally invasive techniques, such as shoulder arthroscopy, which allows us to remove osteophytes, improve mobility and reduce pain. In advanced cases, shoulder endoprosthesis - total or partial replacement of the joint with a prosthesis - may be indicated.

• Post-operative care

  Postoperative care includes an individually tailored rehabilitation program aimed at regaining function as quickly as possible. Immediately after surgery, we provide pain control and immobilization of the arm in a special stabilizer or sling. In the next stage, we implement appropriate physiotherapy, initially consisting of passive exercises and gradually increasing in intensity to active exercises that strengthen the muscles and improve the range of motion of the joint. The patient remains under the regular supervision of an orthopedic surgeon to monitor the progress of treatment.

• Treatment results

  Thanks to the use of modern treatment methods and precisely planned rehabilitation, in most patients we achieve a significant reduction in pain and a significant improvement in the function of the upper limb. Patients regain comfort in life, allowing them to return to daily and occupational activities. The best results are achieved with early implementation of treatment and consistent implementation of the rehabilitation program. In the case of surgical treatment, especially endoprosthesis, the results are very good, and the therapeutic effect is permanent and satisfactory for the patient.

Diabetic foot and vascular disorders are serious complications of diabetes that can lead to significant health problems in the lower extremities. These conditions require a comprehensive therapeutic approach and close cooperation between specialists in different fields.

Charcot deformity

• Description of the disease

  Charcot deformity (Charcot neuroarthropathy) is a progressive disorder of the osteoarticular system, most often affecting the foot and ankle joint. It occurs due to loss of pain sensation and proprioception, usually against a background of diabetic neuropathy or other neurological conditions. The lack of pain sensation causes micro-injuries that the patient does not notice. As a result, bone and joint damage develops, leading to deformities such as kinks in the arch of the foot, pathological displacement of bones, and deformities such as rocker-bottom foot ("rocker-bottom foot"). The resulting deformities significantly limit the function of the foot and lead to chronic ulcers and difficulty walking.

• Diagnostics

  Diagnosis of Charcot deformity includes a detailed history and clinical examination of the patient, evaluation of neuropathy (examination of pain sensation, vibration, temperature), and diagnostic imaging. We take X-rays, which can show bone destruction, subluxations, pathological fractures and bony deformities. Additional tests, such as magnetic resonance imaging (MRI), computed tomography (CT) or bone scintigraphy, are often needed, especially if there is diagnostic doubt or a suspected concomitant infection (osteomyelitis).

• Our approach to treatment

  The treatment of Charcot foot deformity at our center is primarily aimed at halting the progression of the disease, preventing complications and restoring the best possible function of the lower limb. In therapy, we use a comprehensive and multidisciplinary approach. Each patient requires an individually tailored treatment plan, taking into account the severity of the deformity, the presence of infection and overall health. Our emphasis is on precise diagnosis, prevention and comprehensive post-operative care, minimizing the risk of recurrence.

• Treatment methods

  The choice of treatment methods for Charcot deformity depends on the severity of the deformity and the patient's clinical condition. In the early stages of the disease, we use conservative treatment: relieving pressure on the limb with special orthoses, plaster dressings (Total Contact Cast - TCC), orthopedic shoes and drug treatment.
  In more advanced cases, surgical treatment is necessary. At our center, we use modern surgical techniques such as corrective osteotomies, stabilization with screws, plates or intramedullary nails, as well as ligament and bone reconstructions with bone grafts. In extreme situations, when the deformity is significant and accompanied by infection, partial bone resection or partial amputation of the foot may be necessary.

• Post-operative care

  Post-operative care is extremely important for Charcot deformity, as it affects the final results of treatment. After surgery, the patient remains under the care of a specialized team including an orthopedist, diabetologist, vascular surgeon, physiotherapist and a nurse specializing in chronic wound management. Adequate weight-bearing of the limb, use of specialized protective footwear, regular wound care and intensive improvement rehabilitation are important. The patient also receives education on glycemic control and recurrence prevention.

• Treatment results

  The results of Charcot deformity treatment are closely dependent on early diagnosis, the severity of the condition and the treatment methods used. Thanks to the use of modern surgical techniques and appropriate post-operative care, most of our patients succeed in restoring foot stability, improving limb function and reducing the risk of further complications. Regular cooperation between the patient and the therapeutic team allows the long-term maintenance of good treatment results and a significant improvement in quality of life.

Chronic ulcers of the lower limb

• Description of the disease

  Chronic ulcers of the lower limb are hard-to-heal, chronic wounds, most often located in the lower leg, ankle or foot area. They usually result from blood supply disorders or venous insufficiency, but can also result from other causes, such as metabolic diseases (e.g. diabetes), trauma or infections. A common risk factor is chronic venous insufficiency, atherosclerosis of the lower extremities, obesity and a sedentary lifestyle. Patients often report chronic pain, swelling, and a significant decrease in quality of life.

• Diagnostics

  Diagnosis of chronic lower limb ulcers includes a thorough medical history and clinical examination. Imaging studies such as Doppler ultrasonography, computed tomography angiography (angio-CT), magnetic resonance imaging (MRI) and arteriography are used in the diagnosis. It is very important to determine the cause of the ulceration (venous, arterial, mixed or neuropathic). Sometimes microbiological tests (cultures) and tissue biopsy are also required, especially if infection or neoplastic lesions are suspected.

• Our approach to treatment

  In our approach, identification and treatment of the root cause of the ulceration and a comprehensive approach to the wound itself are key. We focus on improving circulation, effectively eliminating infection and regenerating damaged tissue. We aim to maximize pain reduction and restore limb function using modern conservative and surgical treatment techniques. We involve an interdisciplinary team of specialists (vascular surgeons, orthopedists, dermatologists, diabetologists and rehabilitation specialists) in the treatment process.

• Treatment methods

  Treatment options for chronic lower limb ulcers include:
  Conservative treatment - appropriate specialized dressings (hydrogel dressings, alginate dressings, foam dressings, silver dressings), compression therapy (compression therapy), local or systemic antibiotic therapy, and regenerative therapy (e.g., VAC negative pressure therapy).
  Pharmacological treatment - the use of drugs to improve blood circulation, anticoagulants and antibiotics.
  Surgical treatment - surgical preparation of the wound, removal of necrotic tissue, interventional treatment of vascular disease (angioplasty, stenting), as well as skin grafts, reconstructive and plastic treatment.
  Supportive therapy - hyperbaric oxygen therapy and the use of physical methods (e.g., laser therapy, ultrasound, magnetotherapy).

• Post-operative care

  Post-operative care is crucial for good results in the treatment of chronic lower extremity ulcers. We regularly monitor the wound healing process, ensuring that dressings are changed appropriately and any infections are controlled. Education of the patient on wound hygiene, self-application of compression therapy and appropriate physical activity to promote blood circulation in the limb is also an important part of post-operative care. Each patient receives comprehensive rehabilitation and specialized care until the ulcer is completely healed.

• Treatment results

  In most cases, our approach enables chronic ulcers to heal successfully and improve the patient's quality of life. Successful treatment depends on early diagnosis, precise identification of causes, and the patient's cooperation in implementing treatment recommendations. With a personalized approach, it is possible to reduce the risk of ulcer recurrence, significantly reduce pain and improve the function of the lower limb. Regular check-ups make it possible to maintain the effects of therapy and react quickly in case of potential complications.

Transverse bone transport

• Description of the disease

  Transverse bone transport is a treatment method used for diabetic foot complicated by chronic, hard-to-heal ulcers or bone infections. Diabetic foot is a complication of diabetes, resulting from impaired blood supply and neuropathy, which leads to damage to the skin, soft tissues and bones. Deep infection of the bones (osteomyelitis) and abnormal architecture of the foot are common problems. Transverse bone transport involves controlled cutting of the diseased bone, followed by slow movement of the bone fragments, allowing healthy bone tissue to regenerate and improving blood supply to the affected area.

• Diagnostics

  The basis of diagnosis preceding transverse bone transport is a detailed clinical evaluation of the patient's foot, including a physical examination, assessment of blood supply and degree of neuropathy. Imaging studies such as x-rays (X-rays), magnetic resonance imaging (MRI) and computed tomography (CT) are also crucial to determine the degree of bone damage and assess the extent of infection. In addition, microbiological cultures are performed from ulcers or infected tissue to identify the pathogen and select appropriate antibiotic therapy.

• Our approach to treatment

  Our priority is the individual approach to the patient based on multidisciplinary cooperation between specialists in orthopedics, diabetology, vascular surgery and rehabilitation. Careful patient assessment and detailed treatment planning are crucial. The transverse bone transport technique is implemented when other conservative treatments fail, and the goal is to avoid amputation, cure infection, restore foot function and improve the patient's quality of life.

• Treatment methods

  The transverse bone transport procedure involves surgical cutting of the affected bone, usually the metatarsal bone, and insertion of a distraction apparatus (usually an Ilizarov apparatus or external mini-fixators). This is followed by gradual and controlled distraction of the bony fragments (about 1 mm per day) to stimulate the formation of healthy bone tissue and improve local blood supply. This process takes several weeks, and the rate and extent of bone transport are constantly monitored by the attending physician. At the same time, intensive antibiotic therapy is implemented, as well as topical wound therapy, if ulceration is present.

• Post-operative care

  After surgery, the patient requires careful and systematic postoperative care. Regular surgical and radiological follow-up is necessary to monitor the progress of treatment. Proper hygiene and care of the surgical site, prevention of infections and close control of the patient's blood glucose levels are important. In addition, rehabilitation, including strengthening exercises, joint mobilization and gradual loading of the limb under the supervision of a physiotherapist, plays a key role.

• Treatment results

  Transverse bone transport in the treatment of the diabetic foot allows for a significant improvement in blood supply and regeneration of healthy bone tissue. The use of this technique makes it possible to cure chronic infections, close ulcers and avoid amputation of the limb in a significant percentage of cases. Many patients achieve good functional results, allowing them to return to activities of daily living. A key element of effectiveness, however, is the patient's close cooperation with specialists and adherence to recommendations for diabetes control and foot care.

• For whom.
  -Children with excessive spasticity or activity of certain muscle groups, resulting in improper movement patterns or deformities.
  - Mainly used in cerebral palsy to reduce abnormal movement and allow a more correct pattern to be trained.
• Main goals and objectives:
  - To reduce pathological motor patterns.
  - Enabling the child to safely exercise in a specific limb position, which helps in re-education of movement.
  -To support the treatment of spasticity in combination with other methods (e.g., Botox, motor rehabilitation).

• Methods and tools:
  - Application of so-called inhibitory casts (inhibiting casts) in a position that prevents uncontrolled bending, twisting or weight transfer to the wrong area.
  - Concurrent occupational therapy and kinesitherapy to develop new movement patterns.
  -Monitoring and possible modifications of the setting during the turnaround.

• For whom.
  -Children who have been treated with botulinum toxin (Botox) to temporarily reduce spasticity in specific muscle groups (e.g., for MPD, dystonias).
• Main goals and objectives:
  -Taking advantage of the "therapeutic window" - a period when reduced muscle tension allows for more effective stretching and learning of new movement patterns.
  -Preventing the recurrence of contractures through intensive motor rehabilitation.
  -Improving range of motion, strengthening antagonistic muscles and training functional activities.
• Methods and tools:
  -Intensive physiotherapy aimed at stretching and strengthening muscles that have received botulinum toxin injections.
  -Orthosis, taping (e.g., kinesiotaping) to maintain proper joint alignment.
  -Occupational therapy focusing on improving manual skills and daily activities.

• Who it's for.
  - Children with hemiplegia, hemiparesis or limb asymmetry, usually in the course of MPD.
  - "babyCIMT" - dedicated to the youngest children, in whom we want to promote the use of the weaker limb at an early stage.
• Main goals and objectives:
  - Involves immobilization (e.g., in a brace, sleeve) of the dominant/faster limb to force use of the limb affected by the paresis.
  - Intensive activity training (known as task practice) to allow functional improvement of the weaker arm/leg.
  - Improving coordination, increasing strength and range of motion in the previously less-used limb.
• Methods and tools:
  - Occupational therapy in the form of games, manual and functional exercises performed mainly with the weaker limb.
  - Gradual introduction of a variety of activities - from simple manipulations to more complex tasks
  - Motivating the child through attractive forms of exercise, involving parents in the therapeutic process.

• For whom.
  -Children who, in addition to standard motor rehabilitation, need support in daily activities and encouragement to exercise in the form of play and practice.
  - Especially recommended for children with difficulties in independence (ADL), motor coordination or movement planning.
• Main objectives and goals:
  - Combining rehabilitation with practical activities (cooking, excursions, thematic activities) to enhance motivation and independence.
  - Improving coordination of hand movements, working with both hands, maintaining balance - during cooking, food preparation, daily activities.
  - Practice motor planning and sequences of actions in natural settings.
• Methods and tools:
  - Therapeutic cooking - the child, together with therapists and parents, prepares food while learning how to cut, mix, measure ingredients.
  - "Traveling" activities may include short trips, sightseeing, outdoor tasks.
  - At the same time: elements of motor rehabilitation, strength training, coordination exercises tailored to the lesson scenario.

• For whom.
  - Children with impaired motor control, paralysis, paresis, especially when we want to strengthen or "recall" the work of specific muscles.
  - Often used for MPD, meningo-spinal hernia, spinal cord injuries.
• Main objectives and goals:
  -Use of safe electrical impulses to induce muscle contraction and learn proper movement (e.g., during walking).
  -Improving muscle strength and muscle coordination.
  -Increasing the child's awareness of how a specific muscle group works.
• Methods and tools:
  -FES combined with walking training (e.g. stimulation of knee extensor muscles, dorsal flexors of the foot).
  -Parallel kinesitherapy: functional exercises, gait re-education, water exercises with electrostimulation (if appropriate equipment is available).
  -Education and instruction of parents, if home stimulation under the supervision of a specialist is possible.

• For whom.
  Children who need to improve physical fitness, endurance, motor coordination.
  It can be aimed at a wide range of patients with various neurological and orthopedic conditions, but also at children who are overweight or have postural problems.
• Main objectives and goals:
  -Gymnastic general development exercises, taking into account the child's limitations and needs.
  -Increasing muscle strength, flexibility, postural stability.
  -Forming the habit of regular physical activity.
• Methods and tools:
  -Group and individual activities using mats, rehabilitation balls, tapes, gymnastic ladders.
  -Breathing, stretching, strengthening, coordination exercises.
  -Movement games and activities appropriately adapted to the capabilities of the participants.

• For whom?
  

  -Children with feeding disorders, food selectivity, swallowing difficulties or oral aversions (often in MPD, autism, genetic diseases).
  -Toddlers with sensory problems related to food.

• Main objectives and goals:
  

  -Assessment and therapy of disorders of the oral-facial apparatus, restoration of normal reflexes and patterns of sucking, swallowing, biting.
  -Gradual introduction of new foods, textures, tastes - breaking sensory barriers.
  -Teaching correct eating posture and supportive feeding techniques (for parents/guardians).

• Methods and tools:
  

  -Feeding therapy (including methods such as SOS Approach to Feeding, BLW - if adapted).
  -Oral exercises: speech therapy massages, stimulation of the speech apparatus and facial muscles.
  -Consultation with a nutritionist, speech therapist, neurologist, psychologist - multi-specialist approach.

For children with MPD (cerebral palsy)

• Aims and objectives:

• Movement improvement and prevention of contractures.
• Improving independence in ADL, communication, social functioning.
• A variety of therapy methods: NDT-Bobath, Vojta (for the youngest), PNF, occupational therapy, hydrotherapy.

For children with SMA (spinal muscular atrophy)

• Aims and objectives:

• Strengthening respiratory muscles, maintaining as much muscle strength and range of motion as possible.
• Prevention of scoliosis, contractures, prevention of respiratory complications.
• Breathing support exercises (breathing techniques, cough assistants), orthotic support.

 Children with meningo-spinal hernia

• Aims and objectives:

• Physical rehabilitation with emphasis on strengthening muscle parts relieved by paralysis, stabilizing the spine.
• Learning how to move effectively (e.g., in orthoses, in a wheelchair), preventing orthopedic deformities.
• Training of activities of daily living, taking care of urinary and skin hygiene (prevention of bedsores).

With genetic diseases

• Aims and objectives:

• A comprehensive approach depending on the type of disease (e.g., Down syndrome, muscular dystrophies, rarer metabolic diseases).
• Multispecialty care - physiotherapy, occupational therapy, speech therapy, psychology.
• Adaptation of methods to the child's cognitive abilities and level of motor development.

Each turnout has its own specifics based on the therapeutic goal and the group it is aimed at. The common denominator, however, remains:

• Individualized approach - assessing needs, setting goals and customizing a rehabilitation plan.

• Multidisciplinary team - physicians (orthopedist, neurologist), physiotherapists, occupational therapists, speech/neurologists, psychologists, nutritionists, orthotists.

• Parallel education of parents - to continue the recommended exercises and care principles at home.
• Continuing therapy at home - consolidating the effects of the turnout is key to the child's long-term functional improvement.

Rehabilitation camps are an intensive form of improvement, often combined with attractive activities (play, excursions, cooking), which increases children's motivation and promotes better results.

• The Sensory Integration (SI) method is a therapy designed to improve sensory processing in children who experience sensory integration difficulties. SI therapy relies on games and activities that stimulate senses such as touch, balance and proprioception to support a child's neurological development and functioning. The method is particularly effective in working with children with autism spectrum disorders, ADHD or learning disabilities, helping them better cope with everyday challenges.

• Functional Individual Scoliosis Therapy is a specialized therapeutic approach aimed primarily at treating scoliosis and other postural defects in children and adolescents. The therapy is based on individually tailored exercises aimed at correcting body alignment, improving muscle stabilization and educating the patient about correct posture. The FITS method combines elements of manual therapy, corrective exercises and body awareness work for a comprehensive approach to treating spinal defects.

• The Prechtel method is a way of assessing global movement patterns in infants, mainly used for early detection of neurological disorders such as cerebral palsy. It analyzes a child's spontaneous movements, paying attention to their quality, fluidity and variability. Early diagnosis based on this method allows rapid implementation of appropriate therapy, which increases the chances of better motor development of the child.

• These are manual therapies used to reduce tension, improve flexibility and increase range of motion in muscles and fascia. They include various techniques, such as massage, myofascial release and stretching, which affect the neuromuscular system. Regular use of these methods can reduce pain, improve circulation and promote tissue regeneration.

• It is a manual therapy technique used in rehabilitation that aims to improve the mobility and flexibility of nerve structures. It involves gently stretching and moving nerves in their natural pathways, which reduces tension, improves blood circulation and reduces pain and numbness. It is used, among other things, for pain syndromes, neuropathies and after injuries to the nervous system.

• It involves the application of elastic, breathable tapes to the skin to support the muscles, joints and lymphatic system. The tapes improve microcirculation, reduce pain, reduce swelling and promote the body's natural healing processes. The technique is widely used in rehabilitation, sports and pain therapy without restricting the patient's range of motion.

• It is a therapeutic technique that uses electrical impulses to stimulate muscles to restore motor function in people with nervous system damage. The electrical impulses induce muscle contraction to improve strength, coordination and range of motion. FES is particularly used in the rehabilitation of people after strokes, spinal cord injuries and other neuromotor disorders

• It is a therapeutic method used in physiotherapy that involves inserting a thin needle (without administering substances) into trigger points or tight muscle bands to reduce pain, relax muscles and improve function. The technique works by mechanically acting on tissues, which can speed up recovery, improve blood circulation and reduce inflammation. Dry needling is often used to treat myofascial pain, sports injuries and chronic pain.

• It is a therapeutic method used in physiotherapy that involves inserting a thin needle (without administering substances) into trigger points or tight muscle bands to reduce pain, relax muscles and improve function. The technique works by mechanically acting on tissues, which can speed up recovery, improve blood circulation and reduce inflammation. Dry needling is often used to treat myofascial pain, sports injuries and chronic pain conditions

• Galileo vibration platform therapy involves stimulating the muscles and nervous system with vibrations. The patient stands on a platform that generates vibrations at different frequencies, which helps improve muscle strength, coordination and balance. This is often used in rehabilitation and sports training.

• This is a physiotherapeutic method that uses special tools (such as hard plastic or metal instruments) to work on soft tissues such as muscles, fascia, tendons or ligaments. The technique involves mechanically acting on the tissues to reduce pain, break up adhesions, improve blood circulation, increase flexibility and speed up recovery. Popular tool therapy methods include ASTYM.

• It is a rehabilitation method that focuses on improving hand function in patients after neurological damage. It involves limiting the use of the healthy hand to force the patient to use the weakened limb intensively. The therapy aims to restore function and improve the precision of movements by increasing neurological activity in the damaged part of the brain.

• This is a modern rehabilitation method that uses a special system to relieve the patient's weight. Thanks to the harness and dynamic support, the patient can safely practice gait, balance and motor coordination, minimizing the risk of falling. This system is particularly useful in neurological and orthopedic rehabilitation, supporting people with gait disorders, muscle weakness or balance difficulties.

• Plastering is a technique used in physiotherapy for children and adults with cerebral palsy, Duchenne muscular dystrophy, and cerebrocranial injuries, among others, i.e. wherever neurological disorders affect the patient's range of motion. Orthopedic plastering becomes a key therapeutic component when there is an increase in muscle tone, muscle stiffness, toe-walking, joint linearity disorders or general restriction of range of motion.