{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:24:57Z","timestamp":1786116297173,"version":"build-2736575974"},"reference-count":19,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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 \u00b1 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\u201313 (moderate), 7\u201310 (severe), and 4\u20137 (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.<\/jats:p>","DOI":"10.3390\/children13081001","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:16:52Z","timestamp":1785313012000},"page":"1001","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early\u00a0Functional Mobility After Posteromedial Release for Myelodysplastic Clubfoot in Children: Effect of Neurological Level and Quadriceps Function"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9044-6898","authenticated-orcid":false,"given":"Burak","family":"Abay","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Medical Faculty, Demiroglu Bilim University, 34381 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-7051","authenticated-orcid":false,"given":"Alp","family":"Ozel","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, 14030 Bolu, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Alatas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Spina Bifida Research Center, Demiroglu Bilim University, 34381 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Eren","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Istanbul Florence Nightingale Hospital, 34381 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s11832-011-0368-9","article-title":"Orthopaedic management of spina bifida\u2014Part II: Foot and ankle deformities","volume":"5","author":"Swaroop","year":"2011","journal-title":"J. Child. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/BPB.0000000000000352","article-title":"Effectiveness of the Ponseti method for treating clubfoot associated with myelomeningocele: 3\u20139 years follow-up","volume":"26","author":"Matar","year":"2017","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ferreira dos Santos, T., Ferraz Ferreira, G., and Nogueira, M.P. (2024). Effectiveness of congenital myelodysplastic clubfoot treatment by the Ponseti method\u2014Systematic review. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0304909"},{"key":"ref_4","first-page":"e27084","article-title":"Targeted minimally invasive percutaneous posteromedial release of residual clubfoot in myelomeningocele patients: A report of two cases","volume":"14","author":"Alsiddiky","year":"2022","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1097\/BPO.0000000000001248","article-title":"Midterm results of the Ponseti method for treatment of clubfoot in patients with spina bifida","volume":"38","author":"Arkin","year":"2018","journal-title":"J. Pediatr. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/BPO.0b013e3181a6bf77","article-title":"Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method","volume":"29","author":"Janicki","year":"2009","journal-title":"J. Pediatr. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.2106\/JBJS.H.00837","article-title":"Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele","volume":"91","author":"Gerlach","year":"2009","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/01.bpb.0000124491.13918.b7","article-title":"Clubfoot release in myelodysplasia","volume":"13","author":"Flynn","year":"2004","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/BPO.0000000000002848","article-title":"Long-term clinical and radiographic results of posteromedial lateral release for neuromuscular clubfoot deformity","volume":"45","author":"May","year":"2025","journal-title":"J. Pediatr. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jos.2018.09.023","article-title":"Posteromedial release combined with arthrodesis of the talocalcaneal and calcaneocuboid joints for equinovarus associated with myelodysplasia: Clinical outcomes assessment preliminary report","volume":"24","author":"Watanabe","year":"2019","journal-title":"J. Orthop. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/01241398-200409000-00011","article-title":"The Functional Mobility Scale","volume":"24","author":"Graham","year":"2004","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1302\/1863-2548.15.200248","article-title":"Myelomeningocele: A new functional classification","volume":"15","author":"Dias","year":"2021","journal-title":"J. Child. Orthop."},{"key":"ref_14","first-page":"106","article-title":"The segmental innervation of the lower limb muscles in man","volume":"35","author":"Sharrard","year":"1964","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/01202412-199504020-00002","article-title":"Classification of clubfoot","volume":"4","author":"Bensahel","year":"1995","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4862","DOI":"10.1080\/09638288.2021.1913650","article-title":"The cross-cultural adaptation, construct validity, and intra-rater reliability of the Functional Mobility Scale in Brazilian Portuguese for children and adolescents with spina bifida","volume":"44","author":"Davoli","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1007\/s00381-013-2146-0","article-title":"Neuro-orthopaedic conditions in spina bifida: Natural course and their management and long-term outcomes","volume":"29","author":"Kumar","year":"2013","journal-title":"Childs Nerv. Syst."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/j.1469-8749.1991.tb14913.x","article-title":"Ambulatory outcome of children with myelomeningocele: Effect of lower-extremity muscle strength","volume":"33","author":"McDonald","year":"1991","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/BPO.0000000000002242","article-title":"Determining incidence and risk factors of pressure injury after orthopaedic surgery in children and adolescents with neuromuscular complex chronic conditions","volume":"42","author":"Samineni","year":"2022","journal-title":"J. Pediatr. Orthop."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1001\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:52:10Z","timestamp":1786006330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":19,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081001"],"URL":"https:\/\/doi.org\/10.3390\/children13081001","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}