Tag Archive for: Ponseti method

The Role of Pirani Scoring in Predicting the Frequency of Casting and the Need for Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot Using the Ponseti Method

Volume 4 | Issue 2 | July-December 2018 | Page: 15-19 | Chukwuemeka O. Anisi, Joseph E. Asuquo, Innocent E. Abang, Michael E. Eyong, Onyebuchi G. Osakwe, Ngim E. Ngim

DOI- 10.13107/ijpo.2018.v04i02.013

Authors: Chukwuemeka O. Anisi, Joseph E. Asuquo, Innocent E. Abang, Michael E. Eyong [1], Onyebuchi G. Osakwe, Ngim E. Ngim

Departments of Orthopaedics and Traumatology, University of Calabar, Cross River State, Nigeria. [1] Departments of Paediatrics, University of Calabar, Cross River State, Nigeria.

Address of Correspondence
Dr. Chukwuemeka Okechukwu Anisi,
Department of Orthopaedics and Traumatology, University of Calabar Teaching Hospital, PMB 1278-Calabar, Cross River State, Nigeria.
E-mail: iall4him@yahoo.co.uk

Abstract

Background: The Pirani scoring system is a simple tool widely used for grading the severity of clubfoot. This study was designed to objectively assess its value in predicting the total number of casts required, and the need for percutaneous Achilles tenotomy to achieve correction of the idiopathic clubfoot treated by the Ponseti method. Patients and Methods: All patients with idiopathic clubfoot, who attended our clubfoot clinic between January, 2013 and December, 2015, were prospectively studied. Each clubfoot was scored at presentation and at each visit by the first and second authors, using the Pirani scoring system. All patients were treated by the first and second authors by weekly stretching and cast application following the Ponseti treatment protocol until correction was achieved (with or without percutaneous Achilles tenotomy). Chi-square tests were applied to establish any existing relationship between the Pirani scores and the need for percutaneous tenotomy as well as the number of casts required to achieve correction.
Results: A total of 69 patients with 108 idiopathic clubfeet wer recruited into the study. In that, 14 patients defaulted, leaving the study with 81 clubfeet belonging to 55 patients. The median total Pirani score (TPS), midfoot contracture score and hindfoot contracture score at presentation were 4.0, 2.0 and 2.0, respectively. A total of 57 (70.4%) feet required percutaneous Achilles tenotomy to achieve correction. The average number of casts (including casts after tenotomy) required to achieve correction was 4.9 (2–10). The average number of casts required to achieve correction was 4.1 (2–10) for the no tenotomy group and 5.4 (3–10) for the tenotomy group. Statistically significant relationship was established between the TPS and number of casts required to achieve correction for both the tenotomy group (P=0.039) and no tenotomy group (P=0.05).
Conclusion: High Pirani scores were associated with increased number of casts and percutaneous Achilles tenotomy for the correction of idiopathic clubfoot using the Ponseti method.
Keywords: Achilles tenotomy, clubfoot, idiopathic, Pirani scoring system, Ponseti method

References 

1. Solomon L,Warwick D, Selvadurai N.Appley’s Systemof Orthopaedics and Fractures. 9th ed. London: Hodder Arnold; 2010. p. 591-5.
2. Canale ST, Beaty JH. Congenital anomalies of the lower limb. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier 2007. p. 937-55.
3. Ngim NE, Okokon E, Ikpeme IA, Udosen MA, Iya J. Profile of congenital limb anomalies in Calabar. Asian J Med Sci 2013;4:58-61.
4. Adewole AO, Giwa SO, Kayode MO, Shoga MO, Balogun RA. Congenital clubfoot in a teaching hospital in Lagos, Nigeria. Afr J Med Sci 2009;38:203-6.
5. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenital orthopaedic malformations in an African Teaching Hospital. West Afr J Med 2005;24:92-5.
6. Adewole AO, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early experience with Ponseti clubfoot management in Lagos, Nigeria. East Cent Afr J Surg 2014;19:72-7.
7. Ponseti IV. Current concept review. Treatment of congenital clubfoot. J Bone Joint Surg 1992; 74:448-54.
8. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti’s vs Kite’s methods in the treatment of clubfoot − A prospective randomized study. Int Orthop 2008;32:409-13.
9. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113:376-80.
10. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005; 25:623-6.
11. 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.
12. Ponseti IV. Current concept review. Treatment of congenital clubfoot. J Bone Joint Surg 1992;74:448-54.
13. Pirani S, Outerbridge H, Moran M. Method of evaluating the virgin clubfoot with substantial interobserver reliability. Presented at the annual meeting of the Pediatric Orthopaedic Society of North America, Miami, FL, 1995.
14. Dimeglio A, Bensahel H, Souschet P. Classification of clubfoot. J Pediatr Orthop 1995;3:129.
15. Adegbehingbe OO, Asuquo JE, Mejabi OJ, Alzahrani M, Morcuende JA. The heel pad in congenital idiopathic clubfoot: Implications for empty heel for clinical severity assessment. Iowa Orthop J 2015; 35:169-74.
16. Haft GF, Walter CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am 2007;89:487-93.
17. Boehm S, Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB. Early result of the Ponseti treatment of clubfoot in distal athrogryposis. J Bone Joint Surg Am 2008;90:1501-7.
18. Janicki JA, Narayanan UG, Harvey BJ, Roy A, Weir S, Wright JG. Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am 2009;91:1101-8.
19. Porecha MM, Parmar DS, Charda HR. Midterm results of Ponseti method for the treatment of congenital idiopathic clubfoot. J Ortho Surg Res 2011;6:3.
20. Rijal R, Shrestha BP, Singh GK, Singh M, Nepal P, Khanal GP, et al. Comparison of Ponseti’s and Kite’s methods of treatment of idiopathic clubfoot. Indian J Orthop 2010;44:202-7.
21. Morcuende JA, Dobbs MB, Frick SL. Results of the Ponseti method in patients with clubfoot associated with athrogryposis. Iowa Orthop J 2008;28:22-6.
22. Scher DM. The Ponseti method of treatment of clubfoot. Curr Opin Pediatr 2006;18:22-8.
23. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfoot. J Bone Joint Surg Am 2004;86:22-7.
24. Flynn JM, Donohoe M, McKenzie WG. An independent assessment of two clubfoot classification systems. J Pediatr Orthop 1998;18:223.
25. Scher DM, Feldman DS, van Bosse HJ. Predicting the need for tenotomy in the Ponseti method for correction of clubfoot. J Pediatr Orthop 2004;24:349.
26. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone J Surg Br 2006;88:1082-4.
27. BorN,Coplan JA,Herzenberg JE.Ponseti treatment for idiopathic clubfoot: Minimum 5-year follow up. Clin Orthop Relat Res 2009;467:1263-70.

How to Cite this Article:  Anisi CO, Asuquo JE, Abang IE, Eyong EM, Osakwe OG, Ngim E | The Role of Pirani Scoring in Predicting the Frequency of Casting and the Need for Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot Using the Ponseti Method | July-December 2018; 4(2): 15-19.

 

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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.

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