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ABOUT SMFT
SELECTIVE MYOFACIOTOMY
Т
T-tomy (incision) – controlled dissection of fibrotic tissue to increase range of motion and achieve functional improvement.
F-Fascio (connective tissue) – only fibrotically altered fascia and muscle fibers are released
М
M-Myo (muscle) – the intervention targets the muscle surface rather than the tendons.
S-Selective & Subcutaneous
Selective – only fibrotically altered fascia and muscle fibers are dissected, preserving healthy muscle tissue or minimizing its involvement.
Subcutaneous – the procedure is performed through micro-punctures (~2 mm), without the need for surgical incisions.
Selective – only fibrotically altered fascia and muscle fibers are dissected, preserving healthy muscle tissue or minimizing its involvement.
Subcutaneous – the procedure is performed through micro-punctures (~2 mm), without the need for surgical incisions.
A minimally invasive surgical technique designed
to eliminate muscle restrictions caused by fibrotic changes
in the fascia and muscle fibers
to eliminate muscle restrictions caused by fibrotic changes
in the fascia and muscle fibers
S
F
A Comprehensive Treatment Concept
SFMT is not merely a surgical procedure,
but a holistic treatment approach
for orthopedic disorders associated with cerebral palsy (CP)
SFMT is not merely a surgical procedure,
but a holistic treatment approach
for orthopedic disorders associated with cerebral palsy (CP)
Surgical treatment
Selection of individualized assistive rehabilitation devices (orthoses, splints, etc.
Tailored rehabilitation program
Ongoing neuroorthopedic monitoring
Gait analysis performed before and after treatment to assess outcomes
Patient Outcomes:
BEFORE
AFTER
Patient, 9 years old
Equinus deformity of the ankle joints, idiopathic toe walking (ITW). Walks with flat-foot strike post-surgery.
Patient, 9 years old
Equinus deformity of the ankle joints, idiopathic toe walking (ITW). Walks with flat-foot strike post-surgery.
BEFORE
AFTER
AFTER
BEFORE
Patient, 7 years old: Spastic Diplegia
Pre-surgery: adductor contractures of hips, contractures of ankle joints.
Post-surgery: contractures eliminated, walks with flat-foot strike without crossing legs with straight knees.
Post-surgery: contractures eliminated, walks with flat-foot strike without crossing legs with straight knees.
Patient, 7 years old: Spastic Diplegia
Pre-surgery: adductor contractures of hips, contractures of ankle joints.
Post-surgery: contractures eliminated, walks with flat-foot strike without crossing legs with straight knees.
Post-surgery: contractures eliminated, walks with flat-foot strike without crossing legs with straight knees.
BEFORE
AFTER
Indications for Surgery:
SMFT is indicated for children with muscle and fascial contractures caused by fibrosis or pronounced muscle retraction, which limits mobility and may result in pain. It can affect various muscle groups, most commonly the lower limbs (hips, knees, and feet).
If a child with cerebral palsy experiences difficulty walking due to muscle shortening (for example, in equinus deformity where the heel does not contact the ground), SMFT can help correct foot positioning and improve gait stability and confidence, particularly when botulinum toxin therapy is no longer effective.
The procedure is indicated in cases of limited joint mobility, when the child is unable to fully extend the knees or dorsiflex the feet. This is often associated with muscle contractures (due to fibrosis or significant muscle retraction). SMFT helps lengthen the affected muscles, thereby improving joint range of motion.
Our Team
Alexander
Nazarkin
Traumatologist-orthopedist
Worldwide recognized specialist
Leading expert in minimally invasive surgical treatments for orthopedic disorders associated with cerebral palsy, idiopathic toe walking and other pathologies.
Video Profile Worldwide recognized specialist
Leading expert in minimally invasive surgical treatments for orthopedic disorders associated with cerebral palsy, idiopathic toe walking and other pathologies.
15 000+
22+
years of practice
surgeries completed
International Medical Practice:
— Institute for Toe Walking Pomarino (Hamburg, Germany)
— SHB Medikus (Serbia)
— ZiNa Clinic (Prague, Czech Republic)
— Terramed (Moldova)
— Institute for Toe Walking Pomarino (Hamburg, Germany)
— SHB Medikus (Serbia)
— ZiNa Clinic (Prague, Czech Republic)
— Terramed (Moldova)
Mikhail
Basalduk
Pediatric traumatologist-orthopedist, neuroorthopedist, orthotist.
Leading expert in orthopedic treatment of children with cerebral palsy and neuromuscular diseases. Focuses on custom-made orthopedic solutions such as orthoses and insoles based on the patient's specific anatomical needs.
Video Profile Leading expert in orthopedic treatment of children with cerebral palsy and neuromuscular diseases. Focuses on custom-made orthopedic solutions such as orthoses and insoles based on the patient's specific anatomical needs.
16+
years of practice
Education:
— Pirogov Russian National Research Medical University
— North-Western State Medical University named after I.I. Mechnikov
— Landesamt für Gesundheit und Soziales (Germany)
— Pirogov Russian National Research Medical University
— North-Western State Medical University named after I.I. Mechnikov
— Landesamt für Gesundheit und Soziales (Germany)
Evgeniya Tabe
Traumatologist-orthopedist, MD, PhD. Expert in neuroorthopedics. Botulinum therapist. Specialist in gait diagnostics.
Specializes in the diagnosis and treatment of musculoskeletal and neuromuscular disorders, including idiopathic gait abnormalities, cerebral palsy (CP), spinal muscular atrophy (SMA), muscular torticollis, osteochondropathies, scoliosis, and other conditions.
Specializes in the diagnosis and treatment of musculoskeletal and neuromuscular disorders, including idiopathic gait abnormalities, cerebral palsy (CP), spinal muscular atrophy (SMA), muscular torticollis, osteochondropathies, scoliosis, and other conditions.
10 000+
27+
years of practice
patients treated
Education and Internships:
— Crimean State Medical University named after S.I. Georgievsky
— Neuroorthopedics Training: Hannover, Germany — Orthopedic Clinic of Hannover Medical School (MHH) at Annastift
— Internship: Orthopädie Zentrum München Ost (Munich, Germany)
— Crimean State Medical University named after S.I. Georgievsky
— Neuroorthopedics Training: Hannover, Germany — Orthopedic Clinic of Hannover Medical School (MHH) at Annastift
— Internship: Orthopädie Zentrum München Ost (Munich, Germany)
Danila Lobunko
Physical and Rehabilitation Medicine (PRM) Physician
Dr. Lobunko specializes in the application of advanced methods of functional diagnostics and rehabilitation. Utilizes stabilometry and biomechanical motion analysis using inertial sensors and markerless diagnostic systems, enabling precise assessment of movement disorders and the development of effective, individualized rehabilitation programs.
Dr. Lobunko specializes in the application of advanced methods of functional diagnostics and rehabilitation. Utilizes stabilometry and biomechanical motion analysis using inertial sensors and markerless diagnostic systems, enabling precise assessment of movement disorders and the development of effective, individualized rehabilitation programs.
8+
years of practice
Clinical Background:
— Federal Center of Brain Research and Neurotechnologies
— Federal Medical-Biological Agency of Russia
— Basalduk clinic
— Federal Center of Brain Research and Neurotechnologies
— Federal Medical-Biological Agency of Russia
— Basalduk clinic
Comparing Surgery Options: Russia vs. Overseas Clinics
Surgery price:
4 000 EUR
4 000 EUR
Surgery price:
12 000 - 15 000 EUR
12 000 - 15 000 EUR
Travel expenses in Russia:
60 - 170 EUR
60 - 170 EUR
Flight & accommodation costs:
3 000 - 5 000 EUR
3 000 - 5 000 EUR
Communication in native language
Language barrier
Clear medical procedures
Unknown medical system
Friendly environment
Stress for a child
Support with Russian National Rehabilitation Plans (IPRA)
Difficulties with documents
Post-treatment care near you
Remote follow-up care
In our clinic:
Abroad:
*The amounts given are approximate and do not constitute a commercial offer.
How to start?
Surgery Overview
The surgery lasts up to 30 minutes. Compared to traditional methods, it takes significantly less time, as it does not require open intervention and large incisions.
Result without lengthy surgery
The surgeon performs micro-punctures of the skin measuring 1–3 mm, through which fibrotic tissue and restrictive fascia are released. Unlike open procedures, SMFT does not require large incisions or suturing, which reduces the risk of complications and promotes faster healing.
Minimally invasive
The procedure is performed at multiple levels (hip, knee, and lower leg), allowing for the correction of interrelated mobility restrictions within a single intervention. During surgery, the surgeon continuously assesses joint mobility and the degree of muscle relaxation to ensure optimal release while preserving proper muscle function.
Precise correction
The child is under general anesthesia, making the procedure completely painless and allowing precise identification of fibrotic areas: healthy muscles relax under anesthesia, whereas fibrotic tissues do not.
Child comfort and safety secured
Why is this so important?
Rehabilitation
Rehabilitation is a key stage of treatment. It maximizes new mobility potential and secures long-term results.
After surgery, the muscles and tendons are lengthened, making it essential to initiate active movement as early as possible to consolidate the achieved improvements. Insufficient physical activity may lead to recurrence of fibrosis, reducing the overall effectiveness of the treatment.
Proper rehabilitation significantly reduces the risk of spasticity recurrence and the need for future surgical interventions.
After SMFT, the muscles require strengthening and retraining in proper movement patterns. Physical therapy enhances coordination and facilitates the development of new motor skills.
After surgery, the child readapts to their body. Specialists assist in correcting gait and posture by teaching proper movement patterns to improve comfort and function in daily life.
Preserving surgical outcomes
Lowering the risk of revision surgery
Strengthening muscles and improving coordination
Improving Activities of Daily Living
Key elements of rehabilitation
We provide an individualized exercise program designed to restore movement, strengthen muscles, and improve coordination.
Physical therapy
Orthopedic devices are used as needed to stabilize joints and support proper posture.
Orthoses and other Assistive
Devices
Devices
Family support helps ensure adherence to the rehabilitation program and enhances the child’s motivation.
Parents involvement
Exercises begin with minimal load and are progressively increased as the muscles adapt.
Gradual increase in physical load
4
3
2
1
Leading specialists in minimally invasive surgery for cerebral palsy (CP)
Greece,
Athens
Athens
Anastasios Kanellopoulos
USA,
Summit
Summit
Roy
Nuzzo
Nuzzo
Russia,
Moscow
Moscow
Aleksandr Nazarkin
Germany,
Munich
Munich
Peter
Bernius
Bernius
Germany, Langenhagen
Bastian
Fregien
Fregien
How to start?
Contraindications: fixed joint contractures, acute respiratory conditions, hemophilia without appropriate medical management, and significant skin involvement.
Frequently Asked Questions:
Surgery Overview:
- The procedure lasts approximately 15–20 minutes and is performed under general anesthesia.
- During this time, fibrotically altered fascia is released at all pre-planned sites.
- Postoperatively, no casting is required.
- Immobilization of the limb is performed immediately after the procedure while the patient is still under anesthesia.
- A custom removable orthosis is provided to promote faster healing and enable early mobilization.
- The primary criterion for surgical success is the restoration of full or near-full physiological range of motion in the affected joint(s).
- Surgical outcomes are objectively assessed through gait analysis performed before and after the procedure.
- Within 1–2 days, the child can begin weight-bearing in orthoses.
- A structured rehabilitation program is then carried out over a period of approximately 6 months.
Postoperative pain is typically moderate. For the first 5–6 hours after surgery, the child remains pain-free due to the use of non-opioid analgesics and local anesthetics. Subsequently, pain is usually mild, rated at approximately 2–3 on the Visual Analog Scale (VAS) from 1 to 10 (where 10 represents the most severe pain), and is primarily associated with active movements.
Unfortunately, clinical practice shows that in most cases this is not possible.
Minimally invasive procedures, like any surgical intervention, carry certain risks:
Bleeding or damage to nerves and major blood vessels. A procedure-specific risk is disruption of the muscle’s anatomical integrity.
However, the incidence of such complications is extremely low, occurring in less than 1% of cases.
Bleeding or damage to nerves and major blood vessels. A procedure-specific risk is disruption of the muscle’s anatomical integrity.
However, the incidence of such complications is extremely low, occurring in less than 1% of cases.
If clinically indicated, this procedure is essential to avoid future complications in hips.
Required Pre-Admission Medical Tests:
- Complete Blood Count (CBC), including platelets, clotting time and bleeding time — valid for 10 days;
- Urinalysis (UA) — valid for 10 days;
- Hepatitis B (HBsAg) via ELISA — valid for 3 months;
- Hepatitis C (Anti-HCV) via ELISA — valid for 3 months;
- HIV test via ELISA — valid for 3 months;
- Pediatrician’s Clearance: A formal medical report confirming no contraindications for general anesthesia and surgery, including all relevant test results;
- Current Height and Weight;
- Blood Group and Rh Factor.
- Complete Blood Count (CBC), including platelets, clotting time and bleeding time — valid for 10 days;
- Urinalysis (UA) — valid for 10 days;
- Hepatitis B (HBsAg) via ELISA — valid for 3 months;
- Hepatitis C (Anti-HCV) via ELISA — valid for 3 months;
- HIV test via ELISA — valid for 3 months;
- Pediatrician’s Clearance: A formal medical report confirming no contraindications for general anesthesia and surgery, including all relevant test results;
- Current Height and Weight;
- Blood Group and Rh Factor.
Post-surgery:
The timing for follow-up corrections is individualized and depends on the child's growth rate and the effectiveness of his rehabilitation. On average, repeat procedures are performed every 2–4 years.
With adherence to all medical recommendations and ongoing neuroorthopedic monitoring, such risks are not expected.
Follow all medical recommendations provided by your doctor. Topical agents (ointments or balms) may be used to aid the resolution of hematomas, along with adherence to the prescribed postoperative regimen. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used during the first 1–2 days as directed by the physician.
Up to 2-3 hours.
No, walking without orthosis after surgery is forbidden. The child remains in non-removable orthoses for 3 weeks, after which they transition to removable orthoses.
No, this is not true. When performed correctly, myofasciotomy does not cause muscle weakness. On the contrary, by activating muscles that were previously inactive or restricted, their strength typically improves during rehabilitation.
The child begins to achieve full foot weight-bearing, scissoring of the lower limbs resolves, range of motion in the lower limb joints increases, and overall gait quality improves.
In most cases, discomfort may persist for up to 2–3 weeks post-surgery. However, pain during active physical exertion can occur for up to 1.5–2 months post-surgery.
Contacts
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About us
The information provided on this website is for informational purposes only and does not constitute a public offer. To obtain a medical opinion and determine a treatment method, including surgical intervention, please contact a licensed medical specialist.
