Clubfoot Classification

Chu, Alice; Labar, Amy S.; Sala, Debra A.; Bosse, Harold J. P. van; Lehman, Wallace B.

doi:10.1097/bpo.0b013e3181ec0853

Cited by 70 publications

(37 citation statements)

References 18 publications

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“…P. J. Dyer found that the initial Pirani score had a strong link ( r = 0.72, P = 0.0005) to the number of casts, and the correlation remained very high (0.66 and 0.79) when the patients were subdivided into tenotomy and non-tenotomy group, respectively 14 . In contrast, a study of 123 patients found the ICC for the initial total Pirani and Dimeglio scores and number of casts were 0.33 and 0.34, respectively 15 . Another study showed low ( r = 0.21) or no ( r = 0.12) correlation between initial Dimeglio or Pirani score, respectively, and the number of casts, as did the equinus ( r = 0.21) and adduction ( r = 0.17) individual components of the Dimeglio score, and posterior crease ( r = 0.09) or adduction ( r = 0.17) for the individual components of the Pirani score 11 .…”

Section: Discussionmentioning

confidence: 87%

“…One of the questions most frequently asked by parents is how many casts will be needed before correcting the deformity, and accurately informing the parents improves patient treatment compliance. Several studies have investigated the correlation between initial Pirani score or Dimeglio score with the numbers of casts needed to acquire full correction of the deformity, but there is no consensus conclusion that has been drawn 11 , 13 – 15 . To our knowledge, there is no study that has investigated the correlation between initial Pirani score or Dimeglio score and the numbers of casts needed at different severities of the deformity.…”

Section: Introductionmentioning

confidence: 99%

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The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

Fan

Liu

Zhao

et al. 2017

Sci Rep

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The Pirani and Dimeglio scoring systems both have excellent inter-observer and intra-observer reliability, but no research has been conducted to determine their inter-observer reliability and their relationship at different levels of deformity. A total of 173 idiopathic clubfoot cases were reviewed using Pirani and Dimeglio scoring systems, and the number of casts needed was also recorded. For clubfeet with a cast number equal to 2 or 7 and 8, the inter-observer reliability of the two scoring systems was poor or moderate, and there was no correlation between the two scoring systems. There was also no correlation between the Dimeglio scoring score with the number of casts for grade II or IV clubfeet. A binary regression of the number of casts on initial Pirani or Dimeglio scores showed that there was a Quadratic or Cubic relation between the scores and the cast numbers. In conclusion, in the case of mild and very severe clubfoot deformity, the interobserver reliability and its ability to predict the number of casts needed for clubfoot deformity correction was poor. A more objective evaluation system may be required.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

Fan

Liu

Zhao

et al. 2017

Sci Rep

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“…These scores can predict the number of casts required, need for tenotomy and recurrences, but cannot predict compliance with the FAO which is imperative for a successful outcome at long term 8242526. A relapsed clubfoot after Ponseti technique rarely present as an untreated clubfoot.…”

Section: Discussionmentioning

confidence: 99%

Classification of relapse pattern in clubfoot treated with Ponseti technique

Bhaskar

Patni

2013

IJOO

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Background:Relapse of clubfoot deformity following correction by Ponseti technique is not uncommon. The relapsed feet progress from flexible to rigid if left untreated and can become as severe as the initial deformity. No definitive classification exists to assess a relapsed clubfoot. Some authors have used the Pirani score to rate the relapse while others have used descriptive terms. The purpose of this study is to analyze the relapse pattern in clubfeet that have undergone treatment with the Ponseti method and propose a simple classification for relapsed clubfeet.Materials and Methods:Ninety-one children (164 feet) with idiopathic clubfeet who underwent treatment with Ponseti technique presented with relapse of the deformity. There were 68 boys and 23 girls. Mean age at presentation for casting was 10.71 days (range 7-22 days). Seventy three children (146 feet, 80%) had bilateral involvement and 18 (20%) had unilateral clubfeet. The mean Pirani Score was 5.6 and 5.5 in bilateral and unilateral groups respectively. Percutaneous heel cord tenotomy was done in 65 children (130 feet, 89%) in the bilateral group and in 12 children (66%) with unilateral clubfoot.Results:Five relapse patterns were identified at a mean followup of 4.5 years (range 3-5 years) which forms the basis of this study. These relapse patterns were classified as: Grade IA: decrease in ankle dorsiflexion from15 degrees to neutral, Grade IB: dynamic forefoot adduction or supination, Grade IIA – rigid equinus, Grade IIB – rigid adduction of forefoot/midfoot complex and Grade III: combination of two or more deformities: Fixed equinus, varus and forefoot adduction.In the bilateral group, 21 children (38 feet, 28%) had Grade IA relapse. Twenty four children (46 feet, 34%) had dynamic intoeing (Grade IB) on walking. Thirteen children (22 feet, 16%) had true ankle equinus of varying degress (Grade IIA); eight children (13 feet, 9.7%) had fixed adduction deformity of the forefoot (Grade IIB) and seven children (14 feet, 10.7%) had two or more fixed deformities. In the unilateral group seven cases (38%) had reduced dorsiflexion (Grade IA), six (33%) had dynamic adduction (Grade IB), two (11%) had fixed equinus and adduction respectively (Grade IIA and IIB) and one (5%) child had fixed equinus and adduction deformity (Grade III). The relapses were treated by full time splint application, re-casting, tibialis anterior transfer, posterior release, corrective lateral closing wedge osteotomy and a comprehensive subtalar release. Splint compliance was compromised in both groups.Conclusion:Relapse pattern in clubfeet can be broadly classified into three distinct subsets. Early identification of relapses and early intervention will prevent major soft tissue surgery. A universal language of relapse pattern will allow comparison of results of intervention.

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“…Moreover, there has not been accepted unified opinion concerning clear correlation between clinical examination prior to treatment obtained by scoring systems and the outcomes of the treatment in published papers. 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique

Jochymek

Turek

2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity.MethodsA total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8–32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A – mild and group B – severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence.ResultsPirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502).ConclusionTalar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity.Level of evidenceLevel IV, diagnostic study.

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Clubfoot Classification

Abstract: Prognostic Level IV.

Cited by 70 publications

References 18 publications

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

Classification of relapse pattern in clubfoot treated with Ponseti technique

The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique

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