Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: Are we coming to the same decisions?

Lampasi, Manuele; Abati, Caterina Novella; Stilli, Stefano; Trisolino, Giovanni

doi:10.1177/2309499017713916

Cited by 24 publications

(45 citation statements)

References 30 publications

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“…Recently, Lampasi et al (33) described the progression of clinical correction in clubfeet treated with Ponseti method, confirming that the technique basically works as originally anticipated; the frequency of muscle imbalance (i.e., weakness of peroneal muscles) in clubfoot has a great influence on progression of correction, and should be monitored in their evolution. The same group described the progression of clubfoot correction using Ponseti method, individuating the Pirani score as a guide to indication for tenotomy (34); this finding confirmed the statistical significance between initial severity Pirani score and necessity of tenotomy, reported also by Pavone et al (31).…”

Section: Ponseti Methodssupporting

confidence: 71%

From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy

Alberghina¹,

Testa²,

Monforte³

et al. 2021

Ann Transl Med

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This narrative review aims to summarize the historical steps of clubfoot treatment in Italy, identifying the centuries-old historical advancement in the deformity management and the most influent involved people.Background: Clubfoot, also referred to as congenital talipes equinovarus, is a relatively common deformity that has significative consequences in the child if it is left untreated. Effective and early treatment of clubfoot has been praised as one of the most successful practice of modern pediatric orthopedics and both surgical and conservative techniques have been proposed over the decades. As an example, Codivilla's posteromedial release (PMR) has been known internationally as one of the milestones of surgical treatment.Methods: The narrative review includes clinical studies and reviews concerning clubfoot that were written in English, German and Italian. As an historical review, no limits of years were considered. The search was performed using PubMed, Google Scholar, Scopus, Medline and Cochrane Library databases up to January 2021. A combination of search terms including 'history', 'clubfoot', 'conservative management', 'Codivilla', 'Ponseti method', 'relapse' was utilized. Particular attention was given to papers written by Italian authors.Conclusions: Current clubfoot treatment arises from several studies and clinical research over the centuries. Many surgeons, starting from mid-16th century, have studied the deformity trying to find a successful and effective technique to achieve full correction. Italian scientists, surgeons and prestigious institutions surely took part in this process.

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Section: Ponseti Methodssupporting

confidence: 71%

From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy

Alberghina¹,

Testa²,

Monforte³

et al. 2021

Ann Transl Med

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“…On the other hand, other features (posterior crease in DimS = 1, empty heel = 1) are very common, because these are very frequent characteristics of clubfoot at presentation 9,23 and in most cases persist until tenotomy with a sudden correction thereafter. 9,23 Since studies on the reliability of clubfoot scores typically include more feet in the corrective phase than feet at end of treatment, an apparent increase of reliability may result.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation is that we included in the study evaluations performed throughout the corrective casting sessions, whereas the scores were originally intended for initial assessment. 6,7 Yet, with time the applications of the scores have been extended 19,23 and other authors have also examined reliability using similar methods. 2,12,15,17…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: A need for improved scoring systems

Bettuzzi

Abati

Salvatori

et al. 2019

Journal of Children's Orthopaedics

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Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. Conclusions In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. Level of Evidence Level I – Diagnostic studies

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“…Lampasi et al (2017) reported mean of 4.8 point in Pirani scoring, but despite the slight difference, both results showed severe deformity. (11) The first stage of the Ponseti method involves serial plaster cast changes, the mean of casts used by the children during this treatment was 3.94±1.493 and according to literature review in young children like the population in this study, the Ponseti method requires 4 to 6 cast changes. (12) The tenotomy of the Achilles tendon is a common procedure during this technique, it was practiced in 51.8% of the patients in our study without considering children that were still using cast as part of this treatment.…”

Section: Discussionmentioning

confidence: 77%

Outcomes of the Ponseti method for the treatment of children diagnosed with congenital clubfoot in population under five years at Fundación Ruth Paz in San Pedro Sula, Honduras

Sorto

García

Cruz

et al. 2018

OSJ

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Background: Congenital clubfoot is a common deformity characterized by an abnormal development of the foot. The etiology is multifactorial and genetic causes have been related. The Ponseti method is a conservative treatment for the clubfoot, mostly used in idiopathic cases. This method involves serial plaster cast changes, tenotomy of the Achilles tendon and use of braces to prevent relapses. This study was designed to identify the characteristics of the patients diagnosed with congenital clubfoot who were treated with the Ponseti method and the main outcomes of this treatment in children under five years.Method: A retrospective study was conducted in Fundación Ruth Paz in San Pedro Sula, Honduras, since June 1st 2015 to May 31th 2017. This study included patients under five years who were diagnosed with congenital clubfoot and treated with Ponseti method. The data were collected from the clinical files of the identified cases.Results: Congenital clubfoot was more common among males (66.3%) and the localization of the deformity was more commonly bilateral (51.8%). The cases of idiopathic clubfoot represent 91.6% of all the cases. The tenotomy of the Achilles tendon was performed in 51.8% of the patients. Complete treatment was identified in 90.4% of the cases and relapses were reported in 12% of the children who completed treatment.Conclusions: Ponseti method was effective for treat children under five years diagnosed with clubfoot (idiopathic and non-idiopathic) and a significant decrease of the Pirani scoring after treatment was identified in all the cases. A correct use of braces is necessary to avoid relapses.

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Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: Are we coming to the same decisions?

Abstract: Using Pirani score in guiding indication for tenotomy may imply different decisions in a portion of cases, which should be considered when comparing series.

Cited by 24 publications

References 30 publications

From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy

From Codivilla to Ponseti: historical narrative review on clubfoot treatment in Italy

Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: A need for improved scoring systems

Outcomes of the Ponseti method for the treatment of children diagnosed with congenital clubfoot in population under five years at Fundación Ruth Paz in San Pedro Sula, Honduras

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