Significance Of Pirani Score at Bracing-Implications for Recognizing A Corrected Clubfoot

Abstract

Background: The aim of clubfoot treatment by Ponseti method is to achieve a corrected foot, with at least 15° dorsiflexion and 70° abduction, and fit comfortably into a brace at the recommended setting. This study aimed to acknowledge the validity and reliability of the Pirani scoring system, while investigating if a corrected clubfoot has a Pirani score of zero. The study hypothesized that a corrected clubfoot may or may not have a Pirani score of zero.

Methods: 706 patients with clubfoot were treated by Ponseti's method of weekly manipulations and casting, from November 2011 to May 2016, at a tertiary care hospital, making a total of 1055 feet. All data was entered into the International Clubfoot Network Database, along with Pirani scoring. Tenotomy was performed in eligible patients.

Results: The mean Pirani score at the end of treatment phase of casting and initiation of the maintenance phase of bracing for the right foot was 1.1 (SD=0.55) and left foot was 1.2 (SD=0.58). These feet not only fit the criteria of a corrected clubfoot, 70° abduction and 15° dorsiflexion, but also fit well in a foot abduction brace. Of the 1055 diagnosed Clubfeet, 643 required tenotomy (60.9%).

Conclusion: The study shows that the affected foot does not need to have a Pirani score of zero to be considered a corrected foot. Pirani score is an excellent tool used over the years to evaluate clubfoot. Pirani score does not assess adequately the transition from the treatment phase of casting to the maintenance phase of bracing. The use of the International Clubfoot Database-Treatment visit form, including all components of clubfoot and the Pirani score, provides a clear understanding of whether the patient has achieved foot correction or not. Level of Evidence: Level IV.

Keywords: abduction; clubfoot; dorsiflexion; pirani score; ponseti method.

Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1.

Variables in the study.

Figure 2.

International Clubfoot Network Database- Dorsiflexion and Abduction assessment

Figure 3.

The bar graph illustrates the number of feet diagnosed with clubfoot.

Figure 4.

Photographs show corrected clubfoot after manipulation and casting

Figure 5.

The photograph shows a foot-ankle abduction brace. In this patient, feet were clinically corrected, had a Pirani score of greater than zero and fit well in the brace. Three straps present on the brace holds the foot firmly in the shoe.