Predictive value of Pirani scoring system for tenotomy in the management of idiopathic clubfoot

David, Badmus Hakeem; O, Adegbehingbe Olayinka; Esan, Oluwadare; Ayodele, Orimolade E; Mejabi, Joseph Olorunsogo; Arije, Olujide

doi:10.1177/2309499017713896

Cited by 9 publications

(5 citation statements)

References 9 publications

(12 reference statements)

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“…As we lack study in our setup, we were interested in determining the factors that could predict the need for tenotomy in treating idiopathic clubfoot using the Ponseti method. Our study suggests that the higher the pre-Pirani score, the higher the chances of tenotomy, similar to other studies 3,13,14. The average pre-Pirani score among the tenotomy group was 5.3, and that of the non-tenotomy group was 3.5, similar to the study done by Sharma et al3 When the score exceeded the cutoff value of 5, the likelihood of tenotomy increased significantly in our study.…”

Section: Discussionsupporting

confidence: 91%

Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study

Sharma

Banskota

Yadav

et al. 2022

Journal of Pediatric Orthopaedics

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Introduction: Parents of children with clubfoot are likely to inquire about the need for tenotomy and about any factors that may be predictive. The present study was done to identify factors that may help predict the need for tenotomy in children undergoing Ponseti treatment for idiopathic clubfoot. Methods: A prospective observational study was conducted on patients under 5 years of age with idiopathic clubfoot and no previous treatment history treated at Hospital and Rehabilitation Centre for Disabled Children. The relationship between the Pirani score, Dimeglio score, age, and passive ankle dorsiflexion (DF) and the need for heel cord tenotomy was analyzed using appropriate statistical methods. Results: Of 83 patients (125 feet) with a mean age of 6 months, 93 feet (74.4%) required a percutaneous tenotomy. The mean initial Pirani and Dimeglio score for 125 club feet was 4.5 (SD=1.68) and 13.5 (SD=6.1), respectively. The mean initial passive ankle DF was −40.4 (SD=22.31). The Dimeglio (P=0.000), Pirani scores (P=0 .000), and passive ankle DF (P=0.000) showed significant association with the need for tenotomy. Conclusions: This study shows a strong association between initial Pirani and Demiglio scores and initial passive ankle DF as predictive of a heel cord tenotomy. However, age, sex, and laterality were not associated with the need for tenotomy.

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Section: Discussionsupporting

confidence: 91%

Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study

Sharma

Banskota

Yadav

et al. 2022

Journal of Pediatric Orthopaedics

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“…Fifty per cent of cases presented with bilateral deformity [2,10]. The relation between the underlying bony anatomy and the Pirani scoring system was obtained by categorising the TPS into two groups using the 4.5 as cut-off point, above and below, for which the severity and management option differ [9]. Four bony measurements were used to describe each component of the deformity, categorising the four angles measurement into normal, mild, moderate and severe.…”

Section: Discussionmentioning

confidence: 99%

“…The total Pirani score (TPS) was calculated with the obtained data to be grouped into two. Those who have TPS < 4.5, which was considered a low severity group, most probably respond to conservative management, and those with the score of > 4.5 who are regarded as severe, most likely to go for surgery [9]. X-ray images were taken after consenting the parents.…”

Section: Methodsmentioning

confidence: 99%

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Radiological study of anatomical bony arrangement of the clubfoot deformity and its correlation with the Pirani clinical scoring system: A multicenter study

et al. 2019

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Club foot or congenital talipes equinovarus (CTEV) is a common developmental disorder of the foot, affecting 1 per 1,000 live births. The main goal of this study is to evaluate the anatomical bony arrangement of the clubfoot deformity radiologically and to correlate this arrangement with the Pirani clinical scoring system. This descriptive, analytical study was conducted in three centres in Sudan. It recruited all the patients of both sexes with CTEV attending these centres, and excluding children on conservative cast and those who already had surgery. Data were collected using structured questionnaire. Pirani clinical scoring system, a reliable clinical assessment method, was applied. Four angles were used to measure each component of the deformity and correlate this with the Pirani score. Feet radiology was performed to assess the bone anatomy. The index cases number was 25 with male-to-female ratio of 1.6:1. Both feet were involved simultaneously in about half of the cases. Only the dorsoplanter (DP) and lateral (L) views talo-1st metatarsal angle was used to describe the forefoot adduction and midfoot cavus, respectively. These correlated significantly with the clinical score of Pinari, whereas the other two measures for the equinus and varus did not. The results matched with the demographic description of the deformity found in the literature. Further studies are warranted that combine both the clinical assessment and the X-ray measurements in one score to classify the severity of the deformity and guide the management options.

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“…The Ponseti treatment method for idiopathic clubfoot has traditionally included a percutaneous Achilles tenotomy (AT) in more than 85% of severe cases [1][2][3][4][5][6]. The latter is usually performed during the fourth to sixth cast session and has lately proven to be a key factor for the success of nonoperative treatment of this condition [3,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Achilles tenotomy during Ponseti’s clubfoot treatment: better early than late

Ghanem¹,

Ghanem

Rassi³

et al. 2023

Journal of Pediatric Orthopaedics B

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To evaluate the outcome of Achilles tenotomy at first cast in neonates with stiff clubfoot undergoing Ponseti’s method of treatment. One hundred forty stiff clubfeet (Dimeglio grades III and IV) scheduled for Ponseti’s method were prospectively randomized into two groups of 70 each: (1) early, tenotomy at first cast; (2) late, tenotomy at fourth to sixth casts (conventional). The procedure was performed under local lidocaine spray in an office setting using a needle. The results were assessed at an average follow-up of 12.4 years. Technical difficulties and short and long-term complications were recorded. At last follow-up, the results were rated excellent, good, fair, and poor in 70, 18, 9, and 3% of patients in the late group, respectively, and 82, 13, 4, and 1% in the early group (P = 0.048). Technical difficulties were encountered in 38% of the late group and 3% in the early group (P < 0.0001). Flattening of the talar dome of mild to moderate severity was found in 16% of the late group and 4% in the early group (P < 0.001). Early Achilles tenotomy seems to give better results than the conventional late tenotomy, with less short and long-term complications. This may be explained by the greater ease to palpate the Achilles tendon on a previously untreated foot, and the less amount of compressive forces across the tibiotalar and subtalar joints produced by early release of the posterior tether.

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Predictive value of Pirani scoring system for tenotomy in the management of idiopathic clubfoot

Abstract: The indication for tenotomy appears to be well predicted using the Pirani scoring system with the odds of requiring a tenotomy increasing by more than fourfold for every unit increase in Pirani score.

Cited by 9 publications

References 9 publications

Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study

Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study

Radiological study of anatomical bony arrangement of the clubfoot deformity and its correlation with the Pirani clinical scoring system: A multicenter study

Achilles tenotomy during Ponseti’s clubfoot treatment: better early than late

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