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

Sriharsha, Y; Balaji, Gopisankar; Bharathi, D; Patro, Dilip K.

doi:10.1097/bpb.0000000000000835

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…We suggest that early identification of residual clubfeet can be carried out with a carefully performed Pirani score at three months or a lateral radiograph in maximum dorsiflexion at three months, along with measurement of the talocalcaneal and tibiocalcaneal angle. Sriharsha found high correlations between radiographs and the Pirani score [ 26 ]. The limited numbers included in this study do not allow us to prove that the Pirani score is better than the radiograph at predicting additional surgery, but the multivariate data indeed suggest it; moreover, radiation could be spared.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

et al. 2022

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There are few validated predictors of the need for additional surgery in idiopathic clubfeet treated according to the Ponseti method. Our aim was to examine if physical examination (Pirani score) and radiographs at the age of three months (after initial correction of the clubfeet) can predict the future need for additional surgery. In this retrospective cohort study, radiographs of idiopathic clubfeet were made at the age of three months. The Pirani score was determined at the first cast, before tenotomy, and at the age of three months. Follow-up was at least five years. The correlation between the radiograph, Pirani score, and the need for additional surgery was explored with logistic regression analysis. Parent satisfaction was measured with a disease-specific instrument. The study included 72 clubfeet (50 children) treated according to the Ponseti method. Additional surgery was needed on 27 feet (38%). A larger lateral tibiocalcaneal angle (i.e., equinus) and a smaller lateral talocalcaneal angle (i.e., hindfoot varus) at the age of three months were correlated with the need for additional surgery. Higher Pirani scores before tenotomy and at the age of three months also correlated with additional surgery. Parent satisfaction was lower in patients who needed additional surgery. Both the Pirani scores and the lateral radiographs are predictive for future additional surgery.

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Section: Discussionmentioning

confidence: 99%

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

et al. 2022

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“…We did not observe any wound or plaster-related complications in any of the feet. Studies have shown that the initial Pirani score correlates with radiological parameters but is not necessarily correlated to the final outcome in terms of the number of casts required for correction [28,29]. At the final follow-up, all the feet had become plantigrade with a Pirani score of zero, and there were no recurrences.…”

Section: Discussionmentioning

confidence: 99%

Does the use of ultrasound guidance during percutaneous Achilles tendon tenotomy improve outcomes of clubfoot management? A randomized controlled trial

Kumar¹,

Baburaj

Bist³

et al. 2021

Journal of Pediatric Orthopaedics B

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Achilles tenotomy is a crucial aspect in the nonoperative management of clubfoot as per Ponseti's casting protocol. Achilles tenotomy is routinely carried out percutaneously in a blind manner without any image guidance. This study aimed to determine the role of ultrasound-guided percutaneous Achilles tenotomy (PAT) in improving outcomes in clubfoot management. There are no previous studies that have explored the role of image guidance in PAT. This prospective, single-center randomized control trial included 50 clubfoot cases (74 feet) planned for PAT at a mean age of 30.2 months. A single experienced senior surgeon performed tenotomies. Patients were randomized to two groups, with the tenotomies performed under ultrasound guidance in one group (test group) and PAT carried out without image guidance in the other (control) group. Outcome measures assessed included rate of complications, immediate postoperative FLACC score for pain severity and Pirani score at a minimum follow-up of 12 months. There were no significant differences in the complication rates between the test and control groups regarding bleeding, nerve injury and incomplete tenotomies. The mean pain FLACC score was significantly higher in the control group (PAT without image guidance) (P = 0.03), suggesting that the child would better tolerate the ultrasoundguided procedure. All patients in both groups had a Pirani score of zero and plantigrade feet at final follow up, with no relapses. Ultrasound-guided PAT does not have any added advantage over PAT with clinical examination without image guidance in terms of longterm outcomes. Level of evidence: Therapeutic level II.

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“…In this context, some authors reported the involvement of lower limbs genetic mechanisms and possible influence on the development of tarsal bones [5]. Radiographic and sonographic studies on the development of tarsal bone shape in treated clubfeet revealed marked differences from normal feet but observed also some methodological difficulty in detecting morphological differences with these imaging modalities [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

Hämel

Hörterer

Harrasser

2021

BMC Musculoskelet Disord

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Background Major abnormalities of tarsal bone shape after surgical clubfoot treatment are well known from the literature. The Ponseti method has gained widespread acceptance in primary treatment of congenital clubfeet. Despite the longtime experience, data regarding the development of tarsal bones after this treatment are still rare. The aim of the study was therefore to evaluate radiographic parameters describing tarsal bone shape of clubfeet after Ponseti treatment and compare them to age-matched healthy feet. Methods Twenty two consecutive severe clubfeet in 14 patients were investigated by repeated diagnostic ultrasound during the corrective process. Extent and temporal course of correction were documented with standardized X-rays after a mean follow-up of 12 years (between the ages of 10–14 years) and compared to a group of age-matched normal feet. Results Reliability testing for all X-ray parameters showed good to excellent results. In comparison to the control group, all parameters except the radius of the trochlea (RT) were significantly altered in clubfeet with highest differences shown for the anterior talar motion segment (ATM), talonavicular coverage (TNC) and the talometatarsal index (TMT-Index). Differentiation between minor and major deformities showed significant differences only for the front tarsal index (FTI). Conclusions Tarsal bone shape of clubfeet treated by the Ponseti method differs significantly from normal feet. One of the most pronounced and clinically relevant difference of the clubfoot talus compared to the normal talus is the markedly reduced anterior talar motion segment.

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

Cited by 4 publications

References 21 publications

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

Does the use of ultrasound guidance during percutaneous Achilles tendon tenotomy improve outcomes of clubfoot management? A randomized controlled trial

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

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