Predictive ability of scoring systems towards casting in treatment of idiopathic clubfoot by the Ponseti method in infants

Abstract

A prospective study to find a correlation between the severity of clubfoot and the number of casts required for the correction was conducted. The relationship of early relapse with the severity of the deformity was also studied. A total of 42 infants (61 feet) with primary and idiopathic clubfeet were included in the study. Previously treated and clubfeet due to secondary causes were excluded. All clubfeet were treated by the Ponseti method, and the Pirani score, Dimeglio score and Foot Bimalleolar (FBM) angle were taken at presentation and before every casting and at 6 months of follow-up. The average age of the child at presentation was 24 days, the average initial Pirani score was 4.172, the average initial Dimeglio score was 14.36 and the average FBM angle was 63.87 degrees. The average number of corrective casts given was 5.08 (range 2-8). The regression analysis showed a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Eleven of the 61 feet had a relapse (18%). Ten of 11 relapsed feet had a midfoot Pirani score of equal to or more than 2. The regression analysis shows a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Midfoot score equal to or more than 2 is a significant risk factor for relapse.

Are early antero-posterior and lateral radiographs predictive of clubfoot relapse requiring surgical intervention in children treated by Ponseti method?

“… 25 , 26 However, assessing FAO compliance and initial severity scores is subjective. 8 Radiographs can be routinely used in clinical practice and represent an objective evaluation method.…”

“…Only children with a confirmed diagnosis of IC younger than 90 days at the time of first cast application and who had not received any previous orthopedic treatment were included in the study, as well as patients who (1) had to undergo AP and lateral foot radiographs less than 3 months after Achilles tendon lengthening, (2) had to wear the FAO up to 4 years of age, and (3) had to have at least 7 years of clinical follow-up. Additional information such as the severity of the deformity according to Dimeglio’s and Pirani’s classification systems, 7 , 8 number of casts, total time in cast, need for percutaneous Achilles tenotomy, adherence with post-correction brace, complications, relapses, and need for further surgical interventions was collected from the charts.…”

“…[4][5][6] The outcome of the Ponseti technique is primarily assessed with clinical and functional tools such as Dimeglio's and/or Pirani's clinical score systems. 7,8 However, these clinical scoring systems are subjective and do not consider any imaging modality. 9 Imaging methods, such as radiography, are objective and relatively simple to obtain.…”

Does the use of ultrasound guidance during percutaneous Achilles tendon tenotomy improve outcomes of clubfoot management? A randomized controlled trial

“…We did not observe any wound or plaster-related complications in any of the feet. Studies have shown that the initial Pirani score correlates with radiological parameters but is not necessarily correlated to the final outcome in terms of the number of casts required for correction [28,29]. At the final follow-up, all the feet had become plantigrade with a Pirani score of zero, and there were no recurrences.…”