Mid-term results of the posteromedial release in the treatment of relapse clubfoot

Background: Clubfoot (CF) is one of the most common musculoskeletal deformities in newborns, with an incidence of 1–2 per 1,000 live births. While the Ponseti method is the gold standard for initial management and achieves over 90% initial correction rates, relapse remains a significant challenge, particularly in severe cases or in instances of poor compliance with orthotic use. Recurrent CF may require surgical intervention when conservative measures fail. Posteromedial release (PMR) is a well-established surgical technique designed to correct all components of the deformity in a single stage.  Methods: This retrospective study included 16 patients (20 feet) with relapsed idiopathic CF who were treated with PMR after unsuccessful conservative or previous surgical treatment. All surgeries were performed by the same surgeon using Turco’s posteromedial approach. Clinical evaluation was conducted using the Pirani Score (PS) before and after surgery. Radiographic parameters including anteroposterior talocalcaneal angle (ATCA), lateral talocalcaneal angle (LTCA), and anteroposterior talo-first metatarsal angle (ATMA) were measured preoperatively and at final follow-up. Results: The mean patient age was 4.5 years, with a mean follow-up of 2.7 years. The mean PS improved significantly from 4.13 to 0.89 (p = 0.001). Radiological outcomes also showed significant improvement: ATCA increased from 21° to 23° (p = 0.047), LTCA from 20° to 30° (p = 0.002), and ATMA decreased from 45° to 11° (p = 0.001). In addition to PMR, the surgical procedures performed on the patients were as follows: cuboid decancellation, medial column lengthening, lateral cuneiform transfer of the tibialis anterior tendon, split tibialis posterior tendon transfer to the proneus brevis tendon, and multiple metatarsal osteotomies.  Conclusions: PMR is a safe and effective surgical option for the treatment of relapsed congenital clubfoot when conservative methods fail. It allows for satisfactory mid-term correction both clinically and radiologically, with low complication rates and durable outcomes.