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

Abstract

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.

Clubfoot treatment with Ponseti method—parental distress during plaster casting

“…Therefore, we decided to use the Pirani score in our study. Comparing the determined values for the Pirani score at the beginning of treatment, we found similar results (our results: 4.75, Fan et al: [ 1 ] 4.4, Agarwal et al: [ 19 ] 5.0).…”

“…Idiopathic clubfoot is one of the most prevalent musculoskeletal congenital defects (1-2 per 1000 live births), which is not self-healing. The deformity will deteriorate until adulthood and cause adverse effects for the patient, if early treatment does not occur [1].…”

Developing a Three-Dimensional (3D) Assessment Method for Clubfoot—A Study Protocol

“…Clubfoot management is still challenging in terms of its assessment and intervention methods. The accurate evaluation of clubfoot is essential for assessing the initial severity, choosing the treatment options, monitoring and predicting the progress of the intervention, and predicting relapses of the foot (Wainwright et al, 2002 ; Herd et al, 2004 ; Siapkara and Duncan, 2007 ; Ramanathan and Abboud, 2010 ; Jain et al, 2012 , 2017 ; Fan et al, 2017 ). There are several scoring systems that have been used as assessment tools to evaluate the severity of clubfoot deformity.…”

“…However, several studies reported that there is no universal standard assessment method available at present to quantify the initial severity of the clubfoot or monitor the clubfoot treatment (Jain et al, 2001 ; Gigante et al, 2004 ; Dyer and Davis, 2006 ; Ramanathan et al, 2009 ; Ramanathan and Abboud, 2010 ; Yapp et al, 2012 ; Bhaskar and Patni, 2013 ). Because it is difficult to obtain the objective measurements from all these classification systems (Catterrall classification system, Pirani scoring, Dimeglio classification system, and Harrold and Walker classification system) due to subjective in nature (Wainwright et al, 2002 ; Jain et al, 2012 , 2017 ; Fan et al, 2017 ). In view of imaging assessment methods, it provides objective details of severities of the clubfoot.…”

“…Therefore, the International Clubfoot Registry Database (ICRD) suggested to record the biomechanical aspects of objective evaluation methods such as measuring the angle of foot positions of four components of clubfoot deformities (cavus, abduction, varus, and equinus) as well as Pirani score (Khan et al, 2017 ). Due to no agreed standard objective assessment methods for evaluating and monitoring the severities of the clubfoot, many studies suggested that the need of objective assessment method to quantify the severity and predict the prognosis of the treatment (Wainwright et al, 2002 ; Herd et al, 2004 ; Siapkara and Duncan, 2007 ; Ramanathan and Abboud, 2010 ; Jain et al, 2012 , 2017 ; Fan et al, 2017 ), and these studies also stated the assessment should be accurate, reliable, and valid to predict the prognosis of the clubfoot. Therefore, we propose this study by using a low-cost 3D scanner to explore the structural changes in clubfoot and quantify the severity of clubfoot.…”