The Role of Pirani Scoring System in the Management and Outcome of Idiopathic Club Foot by Ponseti Method

Background: Clubfoot is not an embryonic malformation. A normally developing foot turns into a clubfoot during the second trimester of pregnancy. Therefore, like developmental hip dysplasia and idiopathic scoliosis, clubfoot is a developmental deformation. Understanding the pathomechanics and treating successfully clubfoot has always been unsolved mystery for modern medicine. Clubfoot is usually diagnosed immediately after birth simply by looking at the foot. Most Orthopaedic surgeons have agreed that the initial treatment of a clubfoot should be nonsurgical and start as soon as possible after birth. Pirani et al has developed a reliable and valid method of clinically assessing the amount of deformity present in an unoperated congenital clubfoot less than 2 years of age. It allows the treating practitioner to know how patient is responding to treatment, to know when tenotomy is indicated, and to reassure parents regarding progress. Material and method: The subjects included in the study were consecutive patients presenting with Idiopathic CTEV attending Orthopaedic OPD from December 2014 to December 2015. Results: In total there were 25 children (38 feet) presented with idiopathic clubfoot deformity, treated by Ponseti technique. Most of the children were below 6 week of age. When mobility of feet was analysed with respect to different Pirani Score groups, It was also found that mean Pirani Score of supple and rigid feet were 4.76 and 5.5 respectively. The more severe the initial deformity higher Pirani Score, the more casts were required to obtain correction. Conclusion: The study clearly showed that age at initial presentation, quality (mobility) of foot and Pirani Score at presentation, has a direct bearing on final results.