Correlation of Pirani Scoring with the Outcome of Treatment in Idiopathic Congenital Talipes Equinovarus Treated with Ponseti Method: A Prospective Cohort Study

Abstract

Introduction: Congenital Talipes Equino Varus (CTEV) is the most common congenital musculoskeletal malformation and Ponseti method of correction is most commonly used technique. Pirani score is the simplest, reliable and quick to use tool designed to assess the severity of deformity. Aim: To evaluate the results of Ponseti method in children with idiopathic CTEV using modified Pirani score. Materials and Methods: A prospective cohort study was conducted over a period of 18 months from September 2015 to February 2017 in the Departments of Physical Medicine and Rehabilitation (PMR) and Orthopaedics of Safdarjung hospital, New Delhi. Thirty cases representing 47 feet were recruited for the study. They were divided (15 in each) into 0-6 months (younger) and 6-12 months (older) group and were evaluated pre and post Ponseti correction using modified Pirani score in terms of number of casts required, necessity of Percutaneous Tendo-Achilles Tenotomy (PTAT) and the outcome after 12 months of follow-up. Spearman rank correlation coefficient was used for correlation. Results: There was preponderance of bilateral CTEV, 17 (56.6%) and 38 severe cases (80.85%) had mean Pirani score higher (5.52) in older group than in younger group (5.38). Number of casts required to correct the deformity with Pirani score 0 at the end of the treatment was related to severity (p=0.001) and not age (p=0.591). Present study showed 43 feet (91.48%) required PTAT to correct the equinus deformity (p=0.041). Satisfactory outcome was noted in 41 feet (87.23%) of cases at 12 months of follow-up out of which more were in younger age group. Conclusion: Requirement of number of casts and tenotomy was related with severity of CTEV.