Early Functional Mobility After Posteromedial Release for Myelodysplastic Clubfoot in Children: Effect of...

Background: Myelodysplastic clubfoot is rigid, recurrent, and may limit ambulation in children with myelomeningocele. This study evaluated early functional mobility after modified Turco posteromedial release. Methods: Thirty-nine children (55 feet) with myelodysplastic clubfoot who underwent modified Turco posteromedial release after failed conservative treatment were retrospectively reviewed. Functional outcomes were assessed preoperatively and at final follow-up using the Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) at distances of 5, 50, and 500 m. Deformity severity, quadriceps function, complications, recurrence, and reintervention were also recorded. Results: Mean age at surgery was 4.2 ± 2.4 years; mean follow-up was 3.7 years. Median preoperative GMFCS was III, and median preoperative FMS total score was 7. The FMS total score improved across the Dimeglio severity groups: 10-13 (moderate), 7-10 (severe), and 4-7 (very severe). Statistically significant gains were observed at 50 m across all Dimeglio severity groups, reflecting improved school-level mobility. Children with low lumbar involvement improved across all FMS distances; those with thoracic-level involvement showed limited gains. Children with sacral involvement reached higher postoperative FMS scores. Preserved quadriceps function was associated with better functional outcomes. Recurrence occurred in 14 feet (25.4%) and early wound problems in 12 feet (21.8%). Conclusions: Modified Turco posteromedial release was associated with improved distance-specific mobility, particularly in children with low lumbar or sacral neurological levels and preserved quadriceps function. The GMFCS remained largely stable, with limited changes compared to FMS gains.