The Effect of Clinical, Radiographic and Functional Scores on the Total Score in the Evaluation of Congenital Clubfoot

Abstract

Introduction:The use of radical surgical treatments in treating congenital clubfoot is decreasing. Minimally invasive surgical treatment (MIST) is a way of treating congenital clubfoot, which is a kind of compromise between a radical surgical treatment and non-operational one. A few protocols of different authors McKay, Macnicol, Stevens, Meyer, G.W.Simons and Laaveg-Ponseti were used in the evaluation of the results. SCIENTIFIC OBJECTIVE: To determine the importance and role of groups of parameters (clinical, radiographic and functional) in the evaluation of the results in patients treated with the two methods (radical operation and MIST).Subjects and methods:This paper covers children who were treated for structural (idiopathic) form of PEVC. The testing is a prospective study and was conducted in two groups of patients. Group A (radical surgical treatment) – control group, where the total number of subjects was 50, out of which 35 male (70%) and 15 female (30%). The number of feet tested was 88. Group B (minimally invasive surgical treatment–MIST)–experimental group. The total number of subjects was 48, out of which 35 male (73%) and 13 female (27%). The number of feet tested was 84. For the analysis of the results, we used a questionnaire. The total number of parameters was fifteen, clinical, radiographic and functional, five parameters of each. Normal findings or measured value was determined by 0 points. The range of the total score (TS-a- total score range) 0-27 points, and the results were sorted out into the folowing categories: good result (0-5) satisfactory (6-11), poor (12-19) and deformity recrudescence (20-27) points.Results:The proportion of good results at 88 feet in group A was 0,477 as at 84 feet in group B it was significantly higher and came to 0,893. The difference between these proportions is statistically highly significant (t = 5.84, p <0.001). Chi-square test (χ2 = 30.083 df = 1 N = 172, p <0.001) indicated that there is a highly significant correlation between the method of treatment used and results of treatment. Good results of treatment in group A were observed in 48% and in group B in 88% of cases. The Charles Spearman nonparametric method showed that the rank correlation coefficients for the group A are positive, quite high (between 0.70 and 0.85), similar and statistically highly significant (p <0.001). The influence of radiographic scores on the total score is the lowest, and clinical score on the overall score is the highest. Rank correlation coefficients for group B were also positive but somewhat smaller than in group A (between 0.55 and 0.75) and statistically highly significant (p <0.001). It is possible to notice the difference here and say that the impact of functional scores on the total score is the highest and of radiographic score the lowest.Conclusion:Minimally invasive surgical treatment (MIST) gives better functional results in the treatment of congenital clubfoot than radical surgical treatment. The role of radigraphic parameters in the evaluation of the results of ...

Diagnosis and Treatment of Idiopathic Congenital Clubfoot

“…Unless a limb deficiency such as fibular hemimelia, tibial hemimelia, or congenital short femur is noted, radiography is not necessary. 25 Several syndromes are known to be associated with clubfoot, including classic arthrogryposis, multiple pterygium syndrome, distal arthrogryposis, amniotic band syndrome, and Freeman-Sheldon syndrome. [26][27][28] Geneticists can help to evaluate patients when there is suspicion of a syndrome.…”

Do the clinical scores (Pirani and Dimeglio scores) correlate with the radiological parameters in idiopathic club foot in infants? A cross-sectional study

“…Prasad et al [12] studied the correlation between clinical scores and 12 radiological parameters in 30 patients (50 feet) with CTEV who were treated with posteromedial soft tissue release (PMSTR) and they concluded that all the radiological parameters were showing good correlation with clinical parameters. In a study by Rakonjac et al [13] in 48 children (84 feet), radiological score (TaCA in both AP and lateral views, TFM in AP view, TiCA in lateral view, TCI) was correlated against clinical score (Pirani score) in children undergoing radical surgery (group A) and minimally invasive surgery (group B) and proved that there was a significant positive correlation between clinical and radiological score. Similar results were observed in studies done by several other investigators where all the considered radiological parameters had significant correlation with clinical scores [14].…”

“…In a study by Rakonjac et al . [13] in 48 children (84 feet), radiological score (TaCA in both AP and lateral views, TFM in AP view, TiCA in lateral view, TCI) was correlated against clinical score (Pirani score) in children undergoing radical surgery (group A) and minimally invasive surgery (group B) and proved that there was a significant positive correlation between clinical and radiological score.…”