Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method

Abstract

A quite accurate prediction of the number of casts and the need for tenotomy can be performed in most cases. The Dimeglio score showed slightly better accuracy in predicting both steps of Ponseti treatment.

Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: A need for improved scoring systems

“…Reliability of the two scores has been evaluated in few previous studies 2,5,7,10–17 (Table 2) and considered high in most of them. It should be stressed 12,15 that some studies are not independent from the ideators of the scores and that results are not perfectly comparable since different professionals and levels of experience were involved and different methods were used (inclusion of clubfeet throughout treatment or not, inclusion of older children, use of goniometer, etc).…”

“…Efforts should be made to create new scoring systems to combine advantages of the two scores, maintaining those items whose reliability and clinical utility have been proven, 5 and eliminating useless overlapping. Some items have scarce therapeutic (or prognostic) value or inadequate agreement (for example, empty heel) and should be reconsidered.…”

“…1,3 Commonly, they are used to distinguish between different severities of deformity, to monitor progression during correction and to help identify deformity relapse. 1,3 In addition, scores should ideally provide a prognostic contribution: they should anticipate the risk of relapse and relative time needed in foot abduction orthosis in the Ponseti method 4,5 and have a correlation with outcome. A large number of variables have been included in the systems proposed in the literature and it is still unclear which aspects are the most relevant.…”

“…A score (or item) with low reliability compromises every further consideration or correlation. Both Diméglio (DimS) and Pirani (PirS) scores have been considered to have high interrater reliability in terms of total score, 2,5,7,10–17 but reliability of their subcomponents has been evaluated by very few studies. 5,13–17…”

Congenital isolated clubfoot: Correlation between prenatal assessment and postnatal degree of severity

“…The Di Meglio and Pirani scores remain the most widely accepted clubfoot severity grading systems. However, their prognostic value remains questionable, at least in the early treatment stages 16,17 . Since the two grading systems have been reported to have a similar correlation with prognosis, 16,17 we adopted Pirani score as our elective grading score system.…”