Advertisement

International Orthopaedics

, Volume 42, Issue 10, pp 2429–2436 | Cite as

Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method

  • Manuele LampasiEmail author
  • Caterina Novella Abati
  • Camilla Bettuzzi
  • Stefano Stilli
  • Giovanni Trisolino
Original Paper

Abstract

Purpose

The Dimeglio and the Pirani scores are largely used to rate clubfoot at presentation and monitor correction. To date, the accuracy of these scores in predicting appropriate treatment is controversial. The aim of this study was to investigate the accuracy of Dimeglio and Pirani scores in predicting the number of casts and the need for tenotomy in clubfoot correction using the Ponseti method.

Methods

Ninety-one consecutive feet (54 patients; mean age at presentation: 28 ± 15 days) undergoing clubfoot correction using the Ponseti method were prospectively followed from first casting to correction. All feet were scored according to the Dimeglio and Pirani score. The relationships between the two scores, the number of casts and the need for tenotomy were analysed.

Results

Initial correction was achieved in all feet. Both Dimeglio (r = .73; p value < .0005) and Pirani scores (r = .56; p value < .000) showed good association with the number of casts. Multiple linear regression showed a high collinearity of the two scores but a more significant contribution of the Dimeglio score. Among subcomponents, hindfoot score, midfoot score, varus and muscular abnormality were independent predictors of the number of casts. Both Dimeglio and Pirani scores were significantly associated with the need for tenotomy (p value = .0000), and odds ratios and cut-off points were calculated. The receiving operator curve (ROC) analysis showed slightly better performance of the Dimeglio in comparison with the Pirani score in predicting the need for tenotomy, but the difference between the two areas under the curve (AUC) was not significant (p = .48).

Conclusions

A quite accurate prediction of the number of casts and the need for tenotomy can be performed in most cases. The Dimeglio score showed slightly better accuracy in predicting both steps of Ponseti treatment.

Keywords

Clubfoot Ponseti method Achilles tenotomy Pirani score Dimeglio score 

Notes

Compliance with ethical standards

Approval of the local institutional review board was obtained and all parents provided written consensus to treatment and study.

Conflict of interest

One of the authors (C.N. Abati) received a grant from CEDISS Security Engineering, a private donor without profit interest. For the remaining authors, none were declared.

References

  1. 1.
    Ponseti IV (1996) Congenital clubfoot: fundamentals of treatment, 1st edn. Oxford University Press, OxfordGoogle Scholar
  2. 2.
    Bor N, Coplan JA, Herzenberg JE (2009) Ponseti treatment for idiopathic clubfoot: minimum 5-year follow-up. Clin Orthop Relat Res 467:1263–1270CrossRefGoogle Scholar
  3. 3.
    Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, Bazzi JS, Feldman DS (2003) A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 12:133–140Google Scholar
  4. 4.
    Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113:376–380CrossRefGoogle Scholar
  5. 5.
    Abbas M, Qureshi OA, Jeelani LZ, Azam Q, Khan AQ, Sabir AB (2008) Management of congenital talipes equinovarus by Ponseti technique: a clinical study. J Foot Ankle Surg 47:541–545CrossRefGoogle Scholar
  6. 6.
    Smith PA, Kuo KN, Graf AN, Krzak J, Flanagan A, Hassani S, Caudill AK, Dietz FR, Morcuende J, Harris GF (2014) Long-term results of comprehensive clubfoot release versus the Ponseti method: which is better? Clin Orthop Relat Res 472(4):1281–1290CrossRefGoogle Scholar
  7. 7.
    Desai S, Aroojis A, Mehta R (2008) Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 28:53–55CrossRefGoogle Scholar
  8. 8.
    Ippolito E, Farsetti P, Caterini R, Tudisco C (2003) Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am 85-A(7):1286–1294CrossRefGoogle Scholar
  9. 9.
    Goriainov V, Judd J, Uglow M (2010) Does the Pirani score predict relapse in clubfoot? J Child Orthop 4(5):439–444CrossRefGoogle Scholar
  10. 10.
    Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB (2010) Clubfoot classification: correlation with Ponseti cast treatment. J Pediatr Orthop 30(7):695–699CrossRefGoogle Scholar
  11. 11.
    Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop B 4:129–136CrossRefGoogle Scholar
  12. 12.
    Pirani S, Outerbridge HK, Sawatzki B, Stothers K (1999) A reliable method of clinically evaluating a virgin clubfoot evaluation. In: Proceedings of the 21st SICOT World Congress, Sydney, AustraliaGoogle Scholar
  13. 13.
    Flynn JM, Donohoe M, Mackenzie WG (1998) An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 18:323–327PubMedGoogle Scholar
  14. 14.
    Wainwright AM, Auld T, Benson MK, Theologis TN (2002) The classification of congenital talipes equinovarus. J Bone Joint Surg Br 84(7):1020–1024CrossRefGoogle Scholar
  15. 15.
    Shaheen S, Jaiballa H, Pirani S (2012) Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediatr Orthop B 21(4):366–368CrossRefGoogle Scholar
  16. 16.
    Harvey NJ, Mudge AJ, Daley DT, Sims SK, Adams RD (2014) Inter-rater reliability of physiotherapists using the Pirani scoring system for clubfoot: comparison with a modified five-point scale. J Pediatr Orthop B 23(6):493–500CrossRefGoogle Scholar
  17. 17.
    Chaudhry S, Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB (2012) Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B 21(1):73–78CrossRefGoogle Scholar
  18. 18.
    Lampasi M, Trisolino G, Abati CN, Bosco A, Marchesini Reggiani L, Racano C, Stilli S (2016) Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score. Int Orthop 40(10):2199–2205CrossRefGoogle Scholar
  19. 19.
    Lampasi M, Abati CN, Stilli S, Trisolino G (2017) 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? J Orthop Surg (Hong Kong) 25(2):2309499017713916.  https://doi.org/10.1177/2309499017713916 CrossRefGoogle Scholar
  20. 20.
    Gao R, Tomlinson M, Walker C (2014) Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop 34(6):639–642PubMedGoogle Scholar
  21. 21.
    Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles V (2011) An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br 93(3):404–408CrossRefGoogle Scholar
  22. 22.
    Fan H, Liu Y, Zhao L, Chu C, An Y, Wang T, Li W (2017) The correlation of Pirani and Dimeglio scoring systems for Ponseti management at different levels of deformity severity. Sci Rep 7(1):14578.  https://doi.org/10.1038/s41598-017-14977-7 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Gray K, Gibbons P, Little D, Burns J (2014) Bilateral clubfeet are highly correlated: a cautionary tale for researchers. Clin Orthop Relat Res 472(11):3517–3522.  https://doi.org/10.1007/s11999-014-3776-6 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  25. 25.
    Awang M, Sulaiman AR, Munajat I, Fazliq ME (2014) Influence of age, weight, and Pirani score on the number of castings in the early phase of clubfoot treatment using Ponseti method. Malays J Med Sci 21(2):40–43PubMedPubMedCentralGoogle Scholar
  26. 26.
    Dyer PJ, Davis N (2006) The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br 88(8):1082–1084CrossRefGoogle Scholar
  27. 27.
    Zhao D, Li H, Zhao L, Kuo KN, Yang X, Wu Z, Liu J, Zhu J (2016) Prognosticating factors of relapse in clubfoot management by Ponseti method. J Pediatr OrthopGoogle Scholar
  28. 28.
    Aydin BK, Senaran H, Yilmaz G, Acar MA, Kirac Y (2015) The need for Achilles tenotomy in the Ponseti method: is it predictable at the initiation or during the treatment? J Pediatr Orthop B Jul 24(4):341–344CrossRefGoogle Scholar
  29. 29.
    David BH, Olayinka OA, Oluwadare E, Ayodele OE, Joseph OM, Olujide A (2017) Predictive value of Pirani scoring system for tenotomy in the management of idiopathic clubfoot. J Orthop Surg (Hong Kong) 25(2):2309499017713896.  https://doi.org/10.1177/2309499017713896 CrossRefGoogle Scholar
  30. 30.
    Agarwal A, Gupta N (2014) Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop 38(3):569–572CrossRefGoogle Scholar
  31. 31.
    Cosma D, Vasilescu DE (2014) A clinical evaluation of the Pirani and Dimeglio idiopathic clubfoot classifications. J Foot Ankle SurgGoogle Scholar
  32. 32.
    Scher DM, Feldman DS, Van Bosse HJ, Sala DA, Lehman WB (2004) Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 24:349–352CrossRefGoogle Scholar
  33. 33.
    Kang S, Park SS (2015) Lateral tibiocalcaneal angle as a determinant for percutaneous Achilles tenotomy for idiopathic clubfeet. J Bone Joint Surg Am 97(15):1246–1254CrossRefGoogle Scholar
  34. 34.
    Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 86-A(1):22–27CrossRefGoogle Scholar
  35. 35.
    Zhao D, Liu J, Zhao L, Wu Z (2014) Relapse of clubfoot after treatment with the Ponseti method and the function of the foot abduction orthosis. Clin Orthop Surg 6(3):245–252CrossRefGoogle Scholar
  36. 36.
    Moroney PJ, Noël J, Fogarty EE, Kelly PM (2012) A single-center prospective evaluation of the Ponseti method in nonidiopathic congenital talipes equinovarus. J Pediatr Orthop 32(6):636–640CrossRefGoogle Scholar
  37. 37.
    Zionts LE, Packer DF, Cooper S, Ebramzadeh E, Sangiorgio S (2014) Walking age of infants with idiopathic clubfoot treated using the ponseti method. J Bone Joint Surg Am 96(19):e164CrossRefGoogle Scholar
  38. 38.
    Gelfer Y, Dunkley M, Jackson D, Armstrong J, Rafter C, Parnell E, Eastwood DM (2014) Evertor muscle activity as a predictor of the mid-term outcome following treatment of the idiopathic and non-idiopathic clubfoot. Bone Joint J 96-B(9):1264–1268CrossRefGoogle Scholar
  39. 39.
    Kampa R, Binks K, Dunkley M, Coates C (2008) Multidisciplinary management of clubfeet using the Ponseti method in a district general hospital setting. J Child Orthop 2(6):463–467CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Manuele Lampasi
    • 1
    Email author
  • Caterina Novella Abati
    • 1
  • Camilla Bettuzzi
    • 1
  • Stefano Stilli
    • 2
  • Giovanni Trisolino
    • 2
  1. 1.Department of Paediatric Orthopaedics and TraumatologyAnna Meyer Children’s HospitalFlorenceItaly
  2. 2.Department of Paediatric Orthopaedics and TraumatologyIRCCS Istituto Ortopedico RizzoliBolognaItaly

Personalised recommendations