Abstract
Background: Congenital Talipes Equino Varus (CTEV) is a congenital complex deformity. Pirani scoring system is most commonly used for classification. In the Ponseti technique of management, those undergoing tenotomy had higher hindfoot score compared to the non-tenotomy group. Hence evaluation of the factor in hindfoot score of the Pirani scoring system, which can predict the need for tenotomy later is important. Materials and Methods: Hind Foot Score of Pirani Scoring System in the treatment of CTEV by Ponseti Method of serial manipulative corrective casting was evaluated on 40 Infants (up to 1 year of age) with 59 idiopathic clubfeet presenting to orthopedic surgery department of Sri Ramachandra medical college and research institute between June 2010 to June 2012. Results: 51 out of the 59 clubfeet (40 patients) underwent tenotomy [86%]. The mean initial modified Pirani score in the tenotomy group was 4.90, and in a non-tenotomy group, it was 2.44 (p<0.005). The mean hindfoot score in tenotomy and the non-tenotomy group was 2.70 and 1.38 respectively (p <0.005). All children with the rigidity of equinus less than one were corrected by serial casting alone. 98% of clubfeet with the rigidity of equinus score 1 underwent tenotomy. The combination of the severity of posterior crease and rigidity of hindfoot showed 100% with maximum score 2 underwent tenotomy while all below 1.5 scores got corrected by casting alone. Conclusions: Initial rigidity of equinus and severity of posterior crease of hindfoot score of the Pirani scoring system help us in predicting the need for tenotomy later. Combined score of the rigidity of equinus and severity of posterior crease can predict the need for tenotomy better than the emptiness of heel combinations. As the equinus deformity increases to a maximum and posterior crease become severe, then tenotomy is required. Level of evidence: Level 1 High-quality prospective study. The study was started before the first patient enrolled. All patients were enrolled at the same point in their disease with ≥80% follow-up of enrolled patients.
Highlights
Congenital Talipes Equino Varus (CTEV) known as Congenital Clubfoot is a congenital complex deformity which is typically diagnosed immediately after birth[1, 2]
Study population: Children with clubfeet brought to the outpatient section of the study setting, who had undergone treatment through the ponseti method of serial manipulative corrective casting were considered as study population
Exclusion criteria: We excluded children greater than one year of age at the time of the first visit, children previously treated for clubfoot, Postural clubfoot, Clubfoot associated with neuromuscular disease syndromes and chromosomal aberration
Summary
Congenital Talipes Equino Varus (CTEV) known as Congenital Clubfoot is a congenital complex deformity which is typically diagnosed immediately after birth[1, 2]. In the Ponseti technique of management, those undergoing tenotomy had higher hindfoot score compared to the non-tenotomy group. Materials and Methods: Hind Foot Score of Pirani Scoring System in the treatment of CTEV by Ponseti Method of serial manipulative corrective casting was evaluated on 40 Infants (up to 1 year of age) with 59 idiopathic clubfeet presenting to orthopedic surgery department of Sri Ramachandra medical college and research institute between June 2010 to June 2012. The combination of the severity of posterior crease and rigidity of hindfoot showed 100% with maximum score 2 underwent tenotomy while all below 1.5 scores got corrected by casting alone. Conclusions: Initial rigidity of equinus and severity of posterior crease of hindfoot score of the Pirani scoring system help us in predicting the need for tenotomy later. Combined score of the rigidity of equinus and severity of posterior crease can predict the need for tenotomy better than the emptiness of heel combinations. All patients were enrolled at the same point in their disease with ≥80% follow-up of enrolled patients
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