Tag Archive for: Pirani score

Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria

Volume 8 | Issue 3 | September-December 2022 | Page: 06-10| Selema B. Bob-Manuel, Richard C. Echem, Somiari L. Harcourt

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.143

Authors: Selema B. Bob-Manuel FWACS (Ortho) [1], Richard C. Echem FWACS (Ortho) [1], Somiari L. Harcourt FMCS (Ortho) [1]

[1] Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.

Address of Correspondence

Dr. Bob-Manuel Selema Benibo
Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
E-mail: selema_md@yahoo.com

Abstract

Background: Scoring systems are being employed in the objective assessment of the severity of idiopathic clubfoot deformities . Popular among these scoring systems are the Diméglio and Pirani Scoring Systems. This study aims to find the correlation of idiopathic club foot scores (Pirani and Diméglio) with the number of castings by Ponseti method.
Methodology: It was a prospective study carried out over a 12-month period in a tertiary hospital. Children with idiopathic congenital talipes equinovarus under 3 years were included in the study. All data was analysed with the Statistical Package for Social Sciences (SPSS) version 20 for Windows. Pearson correlation coefficient was used to determine the correlation between clubfoot scores and number of castings done.
Results: The study comprised of 42 subjects with a total of 58 feet . Male and females were 45.2% (19) and 54.8% (23) respectively. Idiopathic clubfoot was unilateral in 61.9% of cases. The mean Pirani and Diméglio scores at presentation were 4.58± 1.42 and 14.28± 3.37 respectively. The mean number of casting sessions required to achieve correction was 4.00±1.19. There was a significant positive correlation between total number of castings with both Pirani scores (r=0.449, p<0.05) and Diméglio scores (r=0.619, p<0.05). Fifty percent (50%) of feet required percutaneous tenotomy in the final stages of correction.
Conclusion: Pirani and Diméglio scores have significant correlation with number of casts a patient will require for correction. Thus, either of these scores can be used and are useful tools in the monitoring of patients’ treatment with Ponseti method.
Keywords: Idiopathic Clubfoot, Ponseti, Pirani Score, Diméglio Score, Manipulation and casting.

References

1. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenital orthopaedic malformations in an African teaching hospital. West Afr J Med. 2005;24(2):92–5.
2. Orimolade EA, Ikem IC, Akinyoola AL, Adegbehingbe OO, Oginni LM, Esan O. Pattern of Congenital Musculoskeletal Abnormalities in South West, Nigeria: A Hospital Based Study. Niger J Orthop Trauma. 2013;12(1):52–5.
3. Staheli L. Clubfoot: Ponseti Management. 3rd ed. Global Help; 2009. Available from: https://storage.googleapis.com/global-help-cdn/2020/07/5e0684b9-help_cfponseti.pdf
4. Ponseti I V. Congenital Clubfoot: Fundamentals of treatment. New York: Oxford University Press; 1996.
5. Matos MA, de Oliveira LAA. Comparison between Ponseti’s and Kite’s clubfoot treatment methods: a meta-analysis. J Foot Ankle Surg. 2010;49(4):395–7.
6. Segev E, Keret D, Lokiec F, Yavor A, Wientroub S, Ezra E, et al. Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot. Isr Med Assoc J. 2005;7(5):307–10.
7. Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop. 2014;34(6):639–42.
8. 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(8):1082–4.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129–36.
10. Mejabi JO, Esan O, Adegbehingbe OO, Orimolade EA, Asuquo J, Badmus HD, Anipole AO. The Pirani scoring system is effective in assessing severity and monitoring treatment of clubfeet in children. Br J Med Med Res. 2016;17(4):1-9.
11. Cosma D, Vasilescu DE. A Clinical Evaluation of the Pirani and Dimeglio Idiopathic Clubfoot Classifications. J Foot Ankle Surg. 2015;54(4):582–5.
12. Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J. 2010;30:7–14.
13. Sanghvi A V., Mittal VK. Conservative management of idiopathic clubfoot: Kite versus Ponseti method. J Orthop Surg (Hong Kong). 2009;17(1):67–71.
14. Boakye H, Nsiah A, Thomas A, Bello A. Treatment Outcome of Ponseti Method in the Management of Club Foot at Komfo Anokye Teaching Hospital, Ghana: A Retrospective Study. Arch Curr Res Int. 2016;3(2):1–8.
15. Morcuende JA, Dolan LA, Dietz FR, Ponseti I V. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376–80.
16. Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop. 2014;38(3):569–72.
17. Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160–4.
18. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg Br. 2006;88(3):377–9.
19. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24(4):349–52.
20. Lampasi M, Trisolino G, Abati CN, Bosco A, Marchesini Reggiani L, Racano C, et al. Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score. Int Orthop. 2016;40(10):2199–205.

How to Cite this Article: Bob-Manuel SB, Echem RC, Harcourt SL | Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 06-10. https://doi.org/10.13107/ijpo.2022.v08.i03.143

(Article Text HTML)      (Full Text PDF)

Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria

Volume 7 | Issue 1 | January-April 2021 | Page: 10-15 | Anikwe I.A, Lasebikan O.A, Enweani U.N

Authors: I. A. Anikwe MBBS, FMC Ortho. [1], O. A. Lasebikan MBCHB, MPH, MBA, FWACS, FMC Ortho, FICS [2],
U. N. Enweani MBBS, FMCS, FMCOrtho, FWACS, FICS [3]

[1] Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
[2] Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
[3] Consultant Orthopedic Surgeon, City Hospital Enugu, Nigeria.

Address of Correspondence
Dr. Omolade. A. Lasebikan,
Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
Email: ladelash@yahoo.com

Abstract

Introduction: Congenital clubfoot is a developmental deformity of the foot. Management by the Ponseti method has been shown to be produce better results with fewer complications than traditional surgical methods. Some studies have shown that shorter intervals of serial manipulation/casting provide similar outcome to standard Ponseti technique. This study compared management outcome using an accelerated twice weekly technique, with standard weekly Ponseti casting.
Methodology: A prospective comparative study was conducted involving 62 patients with 90 clubfeet. From the study, 48 clubfeet in 34 patients were managed with standard Ponseti technique (weekly manipulation and casting), while 42 clubfeet in 28 patients were managed with accelerated Ponseti technique (twice weekly manipulation and casting). Pirani score was used for initial assessment and for follow-up.
Results: Children were 1 month to 36 months of age at the time of commencement of treatment. Majority of patients were male, (63%). The average number of casts did not differ significantly between the treatment groups (p = 0.13). The accelerated Ponseti technique patients were therefore able to complete their treatment within a significantly shorter period than those who went through the standard Ponseti protocol. The standard group had mean duration of correction of 29.65±11.69 days and 12.36±5.45 days for the accelerated group (p<0.001). The episodes of early relapses were 2.1% in the standard group and 2.4% in the accelerated group. The rates of complications were comparable between the groups.
Conclusion: Treatment of congenital clubfeet using the twice weekly casting appears to provide comparable outcomes to the weekly Ponseti casting with a significant reduction in the duration of the casting phase.
Keywords: Clubfoot; Pirani score; Ponseti technique; Accelerated.

References 

1. Morrissy RT, Weinstein SL. Clubfoot (Congenital Talipes Equinovarus) Lovell and Winter’s Paediatric Orthopaedics, 6th edition, Lippincott Williams and Wilkins, Philadelphia, 2006; 1262-1273.
2. Bridgens J, Kiely N. Current Management of Clubfoot (Congenital Talipes Equinovarus). British Medical Journal, 2010; 340: 308-311.
3. Dobbs MB, Gurnett CA. Update on Clubfoot: Etiology and Treatment. Clin Orthop Relat Res, 2009; 467(5) 1146-1153.
4. Solomon L, Warwick D. Congential Talipes Equinovarus (Idiopathic Clubfoot). Apley’s System of Orthopaedics and Fractures, 9th ed, Hodder Arnold, an Hachette UK company, London, 2010; 591-595.
5. Kampa R, Binks K, Dunkley M, Coates C. Multidisciplinary Management of Clubfeet Using the Ponseti method in a District General Hospital Setting. Journal of child Orthopaedics, 2008; 2:463-467.
6. Dobbs MB, Nunley R, Schoenecker PL. Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft Tissue Release. J Bone Joint Surg (Am), 2006; 88:986-996.
7. Siapkara A, Duncan R. Congenital Talipes Equinovarus: A review of Current Management. J Bone Joint Surg (Br), 2007; 89-B: 995-1000.
8. Dyer PJ, Davis N. The Role of the Pirani Scoring System in the Management of Clubfoot by the Ponseti Method. J Bone joint Surg (Br), 2006; 88-B: 1082-1084.
9. Herzenberg JE, Radler C, Bor N. Ponseti versus Traditional Methods of Casting for Idiopathic Clubfoot. J Pediatr Orthop, 2002; 22:517-521.
10. Ponseti IV. Common Errors in the Treatment of Congential Clubfoot. International orthopaedic (SICOT), 1997; 21:137-141.
11. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an Accelerated Ponseti Protocol for Cubfoot. J Pediatr Orthop, 2005;25:623-626.
12. Ponseti IV. Current concepts review: Treatment of Congenital Clubfoot. J Bone Surg, Inc, 1992; 74-A: 448-454.
13. Cosma D, Vasilescu D, Vasilescu D, Valeanu M. Comparative results of the conservation Treatment in Clubfoot by two different protocol. J Pediat. Orthop B, 2007; 16:317-321
14. Ukoha U, Egwu OA, Okafor IJ, Ogugua PC, Udemezue OO, Olisah R et al. Incidence of congenital talipes equinovarus among children in Southeast Nigeria. Int. J. Biol Med. Res. 2011; 2(3): 712-715.
15. Adewole OA, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early Experience with Ponseti Clubfoot Management in Lagos, Nigeria. East Cent.Afri.J.surg. 2014; 19(2): 72-77.
16. Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles. An Accelerated Ponseti versus standard Ponseti method: A Prospective Randomized Controlled Trial. J Bone Joint Surg B. 2011; 93(3): 404-408.
17. Sharma P, Yadav V, Verma R, Gohiya A, Gaur S. Comparative Analysis of Results Between Conventional and Accelerated Ponseti Technique for Idiopathic Congenital Clubfoot. OrthopJMPC 2016;22(1):3-7.
18. Elgohary HAS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol. 2015.
19. Ibraheem GH, Adegbehingbe OO, Babalola OM, Agaja SB, Ahmed BA, Olawepo A et al. Evaluation of an Accelerated Ponseti protocol for the treatment of Talipesequinovarus in Nigeria. East Cent.Afr.J.surg. 2016;22(1): 28-38.
20. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J et al. Treatment of Idiopathic Clubfoot using Ponseti Method: Initial experience. J Bone Joint Surg Br. 2006;88-B: 1385-1387.
21. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: A preliminary report. J PediatrOrthop. 2011; 31: 317-319.

How to Cite this Article: Anikwe I.A, Lasebikan O.A, Enweani U.N | Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 10-15.

(Abstract)      (Full Text HTML)      (Download PDF)

Correlation of Pirani Score and Ultrasound in Assessing the Severity of Clubfoot in Neonates Treated by Ponseti Method

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 16-19 | Vineet Bajaj, Rahul Anshuman, Nikhil Verma, Mahipal Singh, Anupama Tandon, Neerav Anand Singh

Authors : Vineet Bajaj [1], Rahul Anshuman [1], Nikhil Verma [1], Mahipal Singh [1], Anupama Tandon [1], Neerav Anand Singh [1].

[1] Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India.

Address of Correspondence
Dr Rahul Anshuman
Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India.
Email: anshuman.cool@gmail.com

Abstract

Aim: The aim of this study is to correlate Pirani score and ultrasound in assessing the severity of clubfoot in neonates treated by Ponseti method.
Materials and Methods: A total of 32 ft with idiopathic congenital talipes equinovarus deformity in neonates were prospectively treated by Ponseti method. Pirani score and ultrasound parameters were measured 3 times, i.e., at the time of initial presentation, at 4 weeks of treatment, and at completion of treatment. Feet were divided according to Pirani score in groups: One (0–2.0), two (2.5–4), and three (4.5–6). Correlation between ultrasound parameters and Pirani score was evaluated using one-way ANOVA and Tukey test.
Results: Correlation between Pirani score and ultrasound parameters was statistically significant (p<0.05).
Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. Ultrasound is objective method to assess the severity of clubfoot. Pirani score and ultrasound correlated in severity of deformity and correction achieved along the course of treatment.
Keywords: Idiopathic congenital talipes equinovarus, Pirani score, Ponseti method, ultrasound.

References 

1. Brewster MB, Gupta M, Pattison GT, Dunn-van der Ploeg ID. Ponseti casting: A new soft option. J Bone Joint Surg Br 2008;90:1512-5.
2. Matuszewski L, Gil L, Karski J. Early results of treatment for congenital clubfoot using the Ponseti method. Eur J Orthop Surg Traumatol 2012;22:403-6.
3. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot–(a study of 67 clubfeet with mean five year follow-up). J Orthop Surg Res 2011;6:3.
4. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am 1963;45:2261-75.
5. Ponseti IV. Clubfoot management. J Pediatr Orthop 2000;20:699-700.
6. Bhargava SK, Tandon A, Prakash M, Arora SS, Bhatt S, Bhargava S. Radiography and sonography of clubfoot: A comparative study. Indian J Orthop 2012;46:229-35.
7. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br 2002;84:1020-4.
8. Shaheen S, Jaibala H, Pirani S. Intraobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopedic surgeon and a physiotherapy assistant. J Pediatr Orthop B 2012;21:366-8.
9. Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: A preliminary report. J Pediatr Orthop 2008;28:53-9.
10. El-Adwar KL, Taha Kotb H. The role of ultrasound in clubfoot treatment: Correlation with the Pirani score and assessment of the Ponseti method. Clin Orthop Relat Res 2010;468:2495-506.
11. Shiels WE 2nd, Coley BD, Kean J, Adler BH. Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol 2007;37:1118-24.
12. Gigante C, Talenti E, Turra S. Sonographic assessment of clubfoot. J Clin Ultrasound 2004;32:235-42.
13. Aurell Y, Johansson A, Hansson G, Wallander H, Jonsson K. Ultrasound anatomy in the normal neonatal and infant foot: An anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 2002;12:2306-12.

How to Cite this Article: Bajaj V, Anshuman R, Verma N, Singh M, Tandon A, Singh A.  Correlation of Pirani Score and Ultrasound in Assessing the Severity of Clubfoot in Neonates Treated by Ponseti Method. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):16-19.

(Abstract)      (Full Text HTML)      (Download PDF)