Prediction of outcome of management of clubfoot using pirani score

Abstract

Background – Clubfoot can be assessed using Pirani scoring system.Ponseti protocol was used in the management of all the patients. The aims of the study were to evaluate outcome of management of idiopathic clubfoot, to correlate outcome with the initial Pirani score and the value of Pirani score in predicting outcome.
Methods- Forty-one children (64 clubfeet) with idiopathic clubfoot were recruited into the study. The children were two years old and less. They were initially assessed using Pirani scoring system and subsequently managed with serial manipulation and cast application weekly with or without tendoachilles tenotomy according to Ponseti protocol. And then followed up for 3 months.
Results- Tenotomy was done in 51.56% of feet. There was a statistically significant difference between the midfoot contracture score, hindfoot contracture score and initial scores in the tenotomy and 'non-tenotomy' groups. The initial Pirani score has a strong positive correlation to the number of casts required. The group that required tenotomy required more cast and as such longer duration of treatment than the 'no tenotomy' group. There was a relapse rate of 2% in the feet of the compliant group while the relapse rate was 69% in the group that were not compliant with use of foot abduction brace. The hindfoot score is a better predictor than both the initial total score and midfoot scores for relapse.
Conclusion- The Pirani scoring system is reliable, quick, and easy to use. The initial Pirani score correlates with duration of treatment. Hindfoot score is a better predictor of tenotomy than midfoot contracture score.