Pirani Score

What is clubfoot?

Clubfoot, also known as talipes equinovarus, is a congenital condition that affects the foot and ankle. It is characterized by the foot being twisted inward or downward, with the sole of the foot facing sideways or even upwards. This results in difficulty walking and wearing shoes, as well as potential pain and discomfort.

The exact cause of clubfoot is still unknown. However, it is believed to be a combination of genetic and environmental factors. It is not caused by anything the mother did during pregnancy, and there is no known way to prevent it.

What is the Pirani Score?

The Pirani scoring system is a widely used tool for assessing the severity of clubfoot deformity in infants. It involves evaluating six clinical signs of contracture in the midfoot and hindfoot, with each sign scored as 0 (no deformity), 0.5 (moderate deformity), or 1 (severe deformity).The six signs assessed are:

• Medial crease
• Curved lateral border
• Lateral head of talus
• Posterior crease
• Empty heel
• Rigid equinus

The total Pirani score ranges from 0 to 6, with a higher score indicating a more severe deformity. A score of 0 would mean no deformity, while a score of 6 represents the most severe clubfoot (Khan et al., 2017).

It's important to note that a corrected clubfoot after Ponseti treatment may not always have a Pirani score of 0, as the score may not fully capture the degree of foot abduction and dorsiflexion in some patients. 

The Pirani Score plays a crucial role in the assessment and treatment of clubfoot in pediatric orthopaedics. This clubfoot scoring system, which involves a detailed physical examination by an orthopedic surgeon, assesses various aspects of the individual foot to assign an initial score. The initial Pirani Score is essential for predicting treatment outcomes, as there is a significant positive correlation between the score and the required interventions.

Effective clubfoot treatment often relies on the accuracy of the Pirani Score, highlighting its significance in the management and correction of the condition. Consequently, understanding the significant correlation provided by the Pirani Score can greatly enhance the predictability and success of treatment protocols for clubfoot.

Benefits of using our template

Our template offers numerous advantages for assessing and managing clubfoot to provide a structured and efficient approach to treatment planning and monitoring. Some of the key benefits:

• Allied health workers and orthopedic surgeons can consistently monitor progress and ensure timely adjustments to the treatment plan.
• The system offers a good forecast for the likely treatment needed, helping predict the number of casts and interventions such as joint surgery or Achilles tenotomy, reducing the risk of relapse.
• With sections for detailed clinical examination and treatment records, this template supports clear communication among healthcare teams, facilitating joint journal entries and comprehensive patient care documentation.
• Particular emphasis on high initial scores allows for better management of severe cases and ensures patients receive appropriate care.
• It supports independent assessment, which is valuable in the management system of Clubfoot and even in settings with limited resources.

Treatment for clubfoot

Most cases of clubfoot can be effectively treated without the need for surgery. The following are some common non-surgical treatment options:

Non-surgical treatment

• Manipulation and casting: This is the most common form of clubfoot treatment. It involves gently stretching the affected foot into the correct position and then placing it in a cast to maintain that position. Over time, as the child grows, new casts will be applied to continue the correction process. This method is typically used in infants under 2 months old.
• Bracing: Once the foot is in the correct position, a brace will be worn for several years to prevent the clubfoot from recurring. There are various types of braces available, such as a foot abduction brace, the Denis-Browne bar or Dobbs brace.
• Physical therapy: This can help improve muscle strength and range of motion in the affected foot.
• Ponseti Method: This method involves gentle manipulation and casting similar to other non-surgical methods, but with a focus on stretching tight ligaments and tendons rather than forcing them into place.

Surgical treatment

If non-surgical methods are not effective or if the clubfoot is severe, surgery may be necessary. There are a few different surgical procedures that may be used:

• Tenotomy: In this procedure, the tight heel cord is cut to allow for greater range of motion in the foot.
• Tendon transfer: This involves moving tendons from one part of the foot to another in order to improve function and alignment.
• Joint fusion: In some cases, fusing one or more joints in the foot can help correct the deformity.

While surgery may be necessary for some cases, it is important to note that non-surgical methods have been found to be effective in the majority of cases. Surgery is usually only recommended if other treatment options have been unsuccessful.

Reference

Khan, M. A., Chinoy, M. A., Moosa, R., & Ahmed, S. K. (2017). Significance of Pirani Score at bracing-implications for recognizing A corrected clubfoot. The Iowa Orthopaedic Journal, 37, 151–156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508266/