Evaluation of hind foot score of Pirani scoring system in treatment of congenital talipes equinovarus by Ponseti method

Abstract

Background: Congenital Talipes Equino Varus (CTEV) is a congenital complex deformity. Pirani scoring system is most commonly used for classification. In the Ponseti technique of management, those undergoing tenotomy had higher hindfoot score compared to the non-tenotomy group. Hence evaluation of the factor in hindfoot score of the Pirani scoring system, which can predict the need for tenotomy later is important.

Materials and Methods: Hind Foot Score of Pirani Scoring System in the treatment of CTEV by Ponseti Method of serial manipulative corrective casting was evaluated on 40 Infants (up to 1 year of age) with 59 idiopathic clubfeet presenting to orthopedic surgery department of Sri Ramachandra medical college and research institute between June 2010 to June 2012.

Results: 51 out of the 59 clubfeet (40 patients) underwent tenotomy [86%]. The mean initial modified Pirani score in the tenotomy group was 4.90, and in a non-tenotomy group, it was 2.44 (p<0.005). The mean hindfoot score in tenotomy and the non-tenotomy group was 2.70 and 1.38 respectively (p <0.005). All children with the rigidity of equinus less than one were corrected by serial casting alone. 98% of clubfeet with the rigidity of equinus score 1 underwent tenotomy. The combination of the severity of posterior crease and rigidity of hindfoot showed 100% with maximum score 2 underwent tenotomy while all below 1.5 scores got corrected by casting alone.

Conclusions: Initial rigidity of equinus and severity of posterior crease of hindfoot score of the Pirani scoring system help us in predicting the need for tenotomy later. Combined score of the rigidity of equinus and severity of posterior crease can predict the need for tenotomy better than the emptiness of heel combinations. As the equinus deformity increases to a maximum and posterior crease become severe, then tenotomy is required. Level of evidence: Level 1 High-quality prospective study. The study was started before the first patient enrolled. All patients were enrolled at the same point in their disease with ≥80% follow-up of enrolled patients.