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

Abstract

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.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

“…We found that a cutoff point of > 70 degrees could predict fair-to-poor functional outcome at walking age with 88.9% sensitivity, similar to the equinus position, which results in a poor quality of life. Similarly, previous studies recommended using this angle to predict risk of relapse and decide the surgical type, such as Achilles tenotomy, soft tissue release, and even reconstructive procedures for recurrent clubfoot, to improve functional outcome, but these studies investigated older children[ 8 , 10 , 11 , 22 , 23 ]. Additionally, a close relationship of clinical and talocalcaneal and talo-1 st metatarsal angles was found in some studies[ 17 , 24 , 25 ].…”