Analysis of Dimeglio Score with Modified Pirani Score for Assessment of Idiopathic Clubfoot Deformity in Infants: A Comparative Study!

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 2-5| Vasu sharma, Vikas Gupta, Daipayan chatterjee, Akshat Sharma

Authors : Vasu sharma [1], Vikas Gupta [2], Daipayan chatterjee [1], Akshat Sharma [1].

[1] Senior Resident, Central Institute of orthopaedics, VMMC & Safdarjung Hospital, New Delhi. India.

[2] Professor, Central Institute of orthopaedics, VMMC & Safdarjung Hospital, New Delhi. India.

Address of Correspondence
Dr. Vasu Sharma

Central Institute of orthopaedics,

VMMC & Safdarjung Hospital,

New Delhi 110029, India.



Background: To evaluate Idiopathic clubfoot deformity of foot, several scoring systems have been proposed and modified Pirani score and Dimeglio score have stood the test of time. There is scarcity of literature comparing the two systems in depth. We tried to compare the scoring systems on user friendliness and predictability to find out whether any superiority exists, if any. We also tried out if Dimeglio score could be used as a guideline for performing tenotomy.
Methods: 82 feet of idiopathic clubfoot deformity were treated by Ponseti’s Plaster technique and evaluated by both modified Pirani and Dimeglio score simultaneously with each cast until full correction was achieved. The scores were compared using standard statistical techniques comparing predictability and user friendliness. Tenotomy was done as per guidelines given by Pirani and corresponding Dimeglio score was assessed and evaluated.
Results: Dimeglio score took longer time as compared to Modified Pirani score. Strong positive correlation was found between corresponding Modified Pirani and Dimeglio Score. Pirani score had statistical significant Plateauing just prior to tenotomy. Dimeglio score of 5 or 6 was found in all cases where tenotomy was done with Equinus score 3 or 2, Curvature of lateral border and Derotation of carpopedal block and Forefoot adduction score 0 or 1, with Cavus, Medial, Posterior crease, Muscle status score 0.
Conclusion: Both Dimeglio and Modified Pirani score have their advantages and shortcomings but most of the scoring correlate well. Dimeglio score can also be used to decide when to do tenotomy.


1. Turco VJ. Clubfoot: Current Problems in Orthopaedics. New York: Churchill Livingstone; 1981.
2. Ponseti IV. Introduction Congenital Clubfoot: Fundamentals of Treatment. Ch. 1. Oxford: Oxford University Press; 1996. p. 1-8.
3. Stern C. Anomalies of genetic origin. Pediatrics 1950;5(2):324-328.
4. Shabtai L, Specht SC, Herzenberg JE. Worldwide spread of the Ponseti method for clubfoot. World J Orthop 2014;5(5):585-590.
5. Göksan SB. Treatment of congenital clubfoot with the Ponseti method. Acta Orthop Traumatol Turc 2002;36(4):281-287.
6. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 2003;12(2):133-140.
7. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45-A:261-344.
8. Catterall A. A method of assessment of the clubfoot deformity. Clin Orthop Relat Res 1991;264:48-53.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995;4(2):129-136.
10. Harrold AJ, Walker CJ. Treatment and prognosis in congenital club foot. J Bone Joint Surg Br 1983;65(1):8-11.
11. Canale ST, beaty JJH, Campbell’s Operative orthopedics. 12th edition. 2013. Elseviers Mosby; . Ch 29: p. 997-1001.
12. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 1998;18(3):323-327.
13. Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Clubfoot classification: correlation with Ponseti cast treatment. J Pediatr Orthop 2010;30(7):695-699.
14. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84(7):1020-1024.
15. Cosma D, Vasilescu DE. A clinical evaluation of the pirani and dimeglio idiopathic clubfoot classifications. J Foot Ankle Surg 2015;54(4):582-585.

How to Cite this Article: Sharma V, Gupta V, Chatterjee D, Sharma A: Analysis of Dimeglio Score with Modified Pirani Score for Assessment of Idiopathic Clubfoot Deformity in Infants: A Comparative Study! International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):2-5.

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