Come scegliere un ortopedico pediatrico a Milano?

L'ortopedico pediatrico si occupa esclusivamente dello scheletro in crescita. A differenza dell'ortopedico dell'adulto, conosce le varianti fisiologiche dell'età evolutiva: molte situazioni che sembrano "problemi" sono in realtà fasi normali della crescita. È utile rivolgersi a uno specialista con formazione dedicata alla pediatria, esperienza clinica continuativa con neonati, bambini e adolescenti, e attività in strutture ospedaliere di riferimento.

Quando portare il bambino dall'ortopedico pediatrico?

Le situazioni più comuni che meritano una valutazione specialistica sono: zoppia improvvisa, dolore persistente a piedi, ginocchia o schiena, piede piatto oltre i 6-7 anni, asimmetria delle spalle o del tronco (sospetta scoliosi), cammino sulle punte dopo i 3 anni, e dolore al tallone o al ginocchio nei giovani sportivi. Nel dubbio, una visita è sempre preferibile all'attesa.

Quanto costa una visita ortopedica pediatrica a Milano?

Il Dott. Priano riceve in regime di libera professione intramoenia (ALPI) presso l'Istituto Gaetano Pini e l'Ospedale CTO di Milano. L'appuntamento si fissa tramite il Call Center Regionale Libera Professione 800 890 890, canale aziendale/regionale, oppure selezionando uno slot su MioDottore, piattaforma esterna e non canale istituzionale dell'ASST: gli appuntamenti selezionati online vengono successivamente registrati nel sistema CUP aziendale prima della visita. Non è necessaria l'impegnativa; tariffa, pagamento e documentazione fiscale sono gestiti esclusivamente da ASST Gaetano Pini-CTO, che rilascia regolare ricevuta.

Quali patologie tratta l'ortopedico pediatrico?

Le patologie più frequenti includono piede piatto, scoliosi, displasia dell'anca nel neonato, ginocchio valgo e varo, cifosi (dorso curvo), tallonite (malattia di Sever), dolore al ginocchio (Osgood-Schlatter), torcicollo del neonato, e fratture e traumi sportivi. L'ortopedico pediatrico si occupa anche dello screening neonatale dell'anca e della valutazione posturale negli adolescenti.

Serve la radiografia prima della visita?

No, nella maggior parte dei casi non è necessario arrivare con radiografie già fatte. L'ortopedico pediatrico valuterà il bambino clinicamente e prescriverà gli esami strumentali solo se necessari e mirati. Radiografie "preventive" spesso non sono utili e espongono il bambino a radiazioni non necessarie.

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Surgery: Flatfoot

Minimally invasive pediatric flatfoot surgery: endosinotarsal subtalar arthroereisis (endorthesis inside the sinus tarsi) and exosinotarsal arthroereisis (calcaneo-stop / C-stop), indications, recovery and specialist evaluation.

Minimally invasive surgery for severe flexible flatfoot

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In short

Flatfoot in children is in the vast majority of cases physiological and evolves with growth. Only a small share requires insoles and an even smaller minority has a surgical indication. The aim of the visit is to distinguish flexible, asymptomatic flatfoot from forms that deserve attention.

When an evaluation can be useful

After 4-5 years if the foot still appears markedly flat
Pain in the foot, ankle or knee during or after activity
The child tires easily when walking or avoids sport
Before buying corrective shoes or insoles on third-party advice

The aim of the visit is not always to start a treatment: often it is to understand whether the situation can be observed calmly or whether further investigation is needed.

Check availability and book

Visits in Milan at Pini and CTO, subject to availability.

When not to wait

Rigid flatfoot (does not correct on tiptoe)
Significant and persistent pain
Clear asymmetry between the two feet

If you recognise one of these signs, a paediatric or orthopaedic evaluation is indicated without delay. The emergency department is necessary only in case of acute trauma, sudden severe pain, inability to bear weight or rapid worsening.

This information does not replace a medical visit and does not allow a diagnosis at a distance.

Surgical Techniques

Endosinotarsal subtalar arthroereisis (endorthesis inside the sinus tarsi)

Minimally invasive technique in which a small implant (endorthesis) is placed inside the sinus tarsi without bone anchoring in the calcaneus. It acts as a spacer limiting excessive hindfoot pronation and guides growth toward a physiological alignment.

When it is used

Symptomatic flexible flatfoot in a growing child (indicatively around 8-12 years, with variable margins) not responding to orthotics and physical therapy after a prolonged period of conservative treatment. Indicated for flexible, manually reducible hindfeet.

Recovery

No cast or brace. Active and passive ankle mobilization from the first day. Weight-bearing is deliberately cautious in the first days, because the implant sits in the sinus tarsi without crossing bone; walking with two crutches for a short period, indicatively until the first check-ups, then free walking. Running and weight-bearing sports are reintroduced gradually, indicatively from the second month: these are orientative windows, personalised on the clinical picture and the technique. The endorthesis is not removed routinely: removal is considered once correction is consolidated, only in case of discomfort or intolerance.

Exosinotarsal subtalar arthroereisis – Calcaneo-stop (C-stop)

Minimally invasive technique in which a small screw is introduced from outside through the calcaneus until it protrudes into the sinus tarsi, where it acts as a mechanical «stop» against excessive valgus-pronation movement of the hindfoot. This is the so-called calcagno-stop or C-stop.

When it is used

Symptomatic flexible flatfoot in the growing child (indicatively around 9-13 years, with variable margins) with hindfoot valgus not controlled by conservative treatment. The choice between endorthesis and calcaneo-stop depends on foot morphology, age and clinical and intraoperative assessment: neither technique is superior in absolute terms.

Recovery

No cast or brace. Active and passive mobilization from the first day. Assisted weight-bearing with two crutches is usually allowed soon after discharge, limiting distances in the first days; crutches are discontinued when the clinical picture allows, indicatively around two weeks. Running and weight-bearing sports are reintroduced gradually, indicatively from the second month, with personalised timing. The transcalcaneal screw is not removed routinely: removal is considered only in case of discomfort, intolerance or a specific indication.

Calcaneal Osteotomy (Evans, Cotton)

Procedure involving bone reshaping of the calcaneus to correct hindfoot alignment. May be necessary in more complex cases or adolescent age.

When it is used

Severe rigid or semi-rigid flatfoot, failed arthroereisis, complex cases.

Recovery

Cast immobilization for some weeks, then progressive weight-bearing. Rehabilitation timing depends on the procedure and the clinical course.

Postoperative Overview

The postoperative course varies for each patient and depends on the surgical technique used. For arthroereisis: no cast or brace, early mobilization with specific exercises and progressive weight-bearing. In bilateral cases, whether to operate both feet in the same session or in two stages is decided case by case, together with the family. Following the personalised rehabilitation programme is essential. The course described below is an indicative pathway, personalised after surgery.

Rehabilitation protocol by technique

Recovery, weight-bearing and return to sport depend on the technique used and on any associated procedures. The protocols below refer to arthroereisis for flexible flatfoot: rigid or semi-rigid feet treated with calcaneal osteotomy follow a different, longer pathway with 4-6 weeks of cast immobilisation, defined case by case.

Endosinotarsal arthroereisisImplant housed in the sinus tarsi: cautious weight-bearing for the first 72 hours, then walking with two crutches.
Exosinotarsal arthroereisis (calcaneo-stop)Transcalcaneal screw with more stable bone purchase: crutch-assisted weight-bearing from discharge.
Arthroereisis + Achilles lengtheningBelow-knee cast for about 30 days and progressive recovery of dorsiflexion, avoiding forced stretching.
Arthroereisis + accessory navicular excisionShort cast of about 15 days protecting the tibialis posterior, then intensive mobilisation and medial scar care.

Endosinotarsal and exosinotarsal arthroereisis (calcaneo-stop): what's the difference?

Minimally invasive flatfoot surgery in children is generically called subtalar arthroereisis. Two main variants exist, depending on where the implant is placed and how it is anchored.

Endosinotarsal arthroereisis uses an endorthesis placed inside the sinus tarsi, without bone anchoring in the calcaneus. The implant acts as a spacer that limits excessive hindfoot pronation.

Exosinotarsal arthroereisis — better known as calcaneo-stop, calcagno-stop or C-stop — uses a small screw introduced from outside through the calcaneus that protrudes into the sinus tarsi, where it works as a mechanical «stop» against valgus-pronation movement.

The choice between endosinotarsal arthroereisis, calcaneo-stop / exosinotarsal arthroereisis or other techniques is not automatic and varies case by case. It depends on the child's age, foot flexibility, degree of hindfoot valgus, presence of pain, possible Achilles tendon contracture, radiographic findings and the surgeon's experience.

Therefore there is no single best technique for all children: the indication must always be personalized to the individual patient and foot.

For parents

Flatfoot: condition information page

Causes, diagnosis, conservative options and when surgery is considered.