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Interobserver variability in Pirani clubfoot severity scoring system between the orthopedic surgeons

  • Original Article
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Abstract

Background

Congenital talipes equinovarus (clubfoot) is one of the most common congenital pediatric orthopedic foot deformity, which varies in severity and clinical course. Assessment of severity of the club foot deformity is essential to assess the initial severity of deformity, to monitor the progress of treatment, to prognosticate, and to identify early relapse. Pirani’s scoring system is most acceptable and popular for club foot deformity assessment because it is simple, quick, cost effective, and easy. Since the scoring system is subjective in nature it has inter- and intra-observer variability, it is widely used. Hence, the interobserver variability between orthopedic surgeons in assessing the club foot severity by Pirani scoring system.

Materials and Methods

We assessed the interobserver variability between five orthopedic surgeons of comparable skills, in assessing the club foot severity by Pirani scoring system in 80 feet of 60 children (20 bilateral and 40 unilateral) with club foot deformity. All the five different orthopedic surgeons were familiar with Pirani clubfoot severity scoring and Ponseti cast manipulation, as they had already worked in CTEV clinics for at least 2 months. Each of them independently scored, each foot as per the Pirani clubfoot scoring system and recorded total score (TS), Midfoot score (MFS), Hind foot score (HFS), posterior crease (PC), emptiness of heel (EH), rigidity of equnius (RE), medial crease (MC), curvature of lateral border (CLB), and lateral head of talus (LHT). Interobserver variability was calculated using kappa statistic for each of these signs and was judged as poor (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), or almost perfect (0.81–1.00).

Results

The mean age was 137 days (range 21–335) days. The mean Pirani score was 3.86. We found the overall consistency to be substantial for overall score (total score kappa - 0.71) and also for midfoot (0.68) and hindfoot (0.66) separately. The consistency was least for the emptiness of heel (kappa - 0.39), and best for rigidity of equnius (kappa - 0.68) and rest of the parameters were moderate (kappa between 0.40 and 0.60).

Conclusion

The Pirani scoring system had got substantial reliability in assessing the clubfoot deformity even when the reliability test was extended to fve different orthopedic surgeons simultaneously.

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References

  1. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84:1020–4.

    Article  PubMed  Google Scholar 

  2. Kelly DM. Congential anomalies of lower extremity. In: Canale ST, Beaty JH, editors. Campbell’s Operative Orthop. 12th ed. St. Louis: Mosby Elsevier; 2008. p. 1078–100.

  3. Jain P, Mehtani A, Goel M, Jain S, Sood A, Kumar Jain A. Correlation of foot bimalleolar angle with Pirani score to assess the severity of congenital talipes equinovarus deformity. J Pediatr Orthop B 2012;21:68–72.

    Article  PubMed  Google Scholar 

  4. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45-A: 261–344.

    Article  Google Scholar 

  5. Catterall A. A method of assessment of the clubfoot deformity. Clin Orthop Relat Res 1991;264:48–53.

    Google Scholar 

  6. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995;4:129–36.

    Article  PubMed  Google Scholar 

  7. Harrold AJ, Walker CJ. Treatment and prognosis in congenital club foot. J Bone Joint Surg Br 1983;65:8–11.

    Article  CAS  PubMed  Google Scholar 

  8. Pirani S, Outerbridge H, Moran M, Sawatsky BJ. A Method of Evaluating the Virgin Clubfoot with Substantial Interobserver Reliability. Miami, Florida: POSNA; 1995;71;99.

  9. Pirani S, Hodges D, Sekeramyi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity (The Canadian Orthopaedic Research Society and the Canadian Orthopaedic Association conference proceeding). J Bone Joint Surg Br 2008;90-B Suppl I: 53.

  10. Jillani SA, Aslam MZ, Chinoy MA, Khan MA, Saleem A, Ahmed SK. A comparison between orthopedic surgeon and allied health worker in Pirani score. J Pak Med Assoc 2014;64 12 Suppl 2:S127–30.

  11. Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediatr Orthop B 2012;21:366–8.

    Article  PubMed  Google Scholar 

  12. Meena S, Sharma P, Gangary SK, Lohia LK. Congenital clubfoot. J Orthop Allied Sci 2014;2:34–9.

    Google Scholar 

  13. Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 2001;21:719–26.

    CAS  PubMed  Google Scholar 

  14. Herbsthofer B, Eckardt A, Rompe JD, Küllmer K. Significance of radiographic angle measurements in evaluation of congenital clubfoot. Arch Orthop Trauma Surg 1998;117:324–9.

    Article  CAS  PubMed  Google Scholar 

  15. Bensahela H, Kuo K, Duhaime M; International Clubfoot Study Group. Outcome evaluation of the treatment of clubfoot: The international language of clubfoot. J Pediatr Orthop B 2003;12:269–71.

    PubMed  Google Scholar 

  16. Macewen GD, Scott DJ Jr., Shands AR Jr. Followup survey of clubfoot treated at the Alfred I. du Pont Institute with special reference to the value of plaster therapy, instituted during earliest signs of recurrence, and the use of night splints to prevent or minimize the manifestations. JAMA 1961;175:427–30.

    CAS  PubMed  Google Scholar 

  17. Wynne-Davies R. Talipes equinovarus. A review of eighty-four cases after completion of treatment. J Bone Joint Surg Br 1964;46:464–76.

    CAS  PubMed  Google Scholar 

  18. Chacko V, Mathew T. Some observations in the treatment of congenital clubfoot. Indian J Orthopaedics 1976;10:127–31.

    Google Scholar 

  19. McKay DW. New concept of and approach to clubfoot treatment: Section II – Correction of the clubfoot. J Pediatr Orthop 1983;3:10–21.

    Article  CAS  PubMed  Google Scholar 

  20. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br 2006;88:1082–4.

    Article  CAS  PubMed  Google Scholar 

  21. Goriainov V, Judd J, Uglow M. Does the Pirani score predict relapse in clubfoot? J Child Orthop 2010;4:439–44.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 2004;24:349–52.

    Article  PubMed  Google Scholar 

  23. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am 2002;84-A: 290–308.

    Article  Google Scholar 

  24. Gelfer Y, Durham S, Daly K, Ewins D. Intraobserver reliability of static measures in the normally developing infant foot and clubfoot. J Pediatr Orthop B 2009;18:214–9.

    Article  PubMed  Google Scholar 

  25. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 1998;18:323–7.

    CAS  PubMed  Google Scholar 

  26. Porter RW, Roy A, Rippstein J. Assessment in congenital talipes equinovarus. Foot Ankle 1990;11:16–21.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Mahavir Hospital, Footi Khothi Sq., Madhya Pradesh, A-2, Sec. C, Sch. 71, Indore, India

    Saurabh Jain, Anand Ajmera, Mahendra Solanki & Alok Verma

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  1. Saurabh Jain
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  2. Anand Ajmera
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  3. Mahendra Solanki
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  4. Alok Verma
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Correspondence to Saurabh Jain.

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Jain, S., Ajmera, A., Solanki, M. et al. Interobserver variability in Pirani clubfoot severity scoring system between the orthopedic surgeons. IJOO 51, 81–85 (2017). https://doi.org/10.4103/0019-5413.197551

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