Effect of age of starting ponseti casts and initial pirani score on the number of casts in ponseti treatment of idiopathic clubfoot in infants

Abstract

Purpose: We chose to assess if starting treatment of Clubfoot with Ponseti casts in neonatal or early infancy can reduce the number of casts required for full correction of the feet. We also analysed the relationship between Pirani scores at commencement of treatment and the number of casts required for correction of the deformity. Methods: Inclusion criteria were idiopathic clubfeet corrected by Ponseti method in children up to one year of age. Children with postural, non-idiopathic, previously surgically treated, recurrent clubfoot were not included in this study. ANOVA regression analysis was used for finding correlation between initial Pirani score, age in weeks and number of corrective casts prior to putting on foot abduction brace. Results: There were a total of 53 children (72 feet) in the study. The average age of the child at presentation was 12 weeks and the average initial Pirani score was 3.4. The average number of corrective casts was six per child (range, 3 to 8). The regression analysis showed both Pirani and age had positive correlation with number of casts, although weak (r2=0.05–0.20). The initial Pirani scoring correlated ten times more than age (in weeks) to the number of casts. Conclusion: The number of casts for correction in idiopathic clubfoot treated in infancy is influenced by both initial Pirani score and age of commencing plasters.