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Does initial Pirani score and age influence number of Ponseti casts in children?
1Department of Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India, rachna_anila@yahoo.co.in.
Insights
The number of corrective casts in the Ponseti method for clubfoot is weakly correlated with both initial Pirani score and patient age. Higher initial Pirani scores showed a stronger influence on the number of casts needed.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Podiatry
Background:
- The Ponseti method is a standard treatment for idiopathic clubfoot.
- Predicting the number of casts required for successful correction is clinically significant.
- Variability in cast numbers necessitates understanding influencing factors.
Purpose of the Study:
- To investigate the correlation between the number of casts and patient age.
- To examine the relationship between the number of casts and the initial Pirani score.
- To analyze these factors in children undergoing the Ponseti method requiring tenotomy.
Main Methods:
- Study included 297 children (442 feet) with idiopathic clubfoot treated by the Ponseti method requiring tenotomy.
- Exclusion criteria included non-compliance, postural deformities, and previous surgery.
- ANOVA regression analysis was used to assess correlations between age, initial Pirani score, and cast number.
Main Results:
- Average age at presentation was 10.3 months; average initial Pirani score was 4.8.
- Average number of corrective casts was seven (range: 2-18).
- Both age and initial Pirani score showed a weak positive correlation with the number of casts (r²=0.05-0.20), with Pirani score having a stronger influence.
Conclusions:
- The number of casts in Ponseti treatment for clubfoot is influenced by initial Pirani score and age.
- Initial Pirani score is a more significant predictor of cast number than age.
- These findings aid in managing expectations and treatment planning for clubfoot.
Purpose:
The prediction of number of casts in the Ponseti method has always remained a subject of interest. We investigated the correlation of the number of casts before tenotomy with the age and initial Pirani score in Ponseti treatment of club foot.
Methods:
Inclusion criteria were idiopathic clubfeet corrected by Ponseti method requiring tenotomy for equinus correction in children up to ten years of age. Defaulters (noncompliance with serial casting schedule), children with postural, non idiopathic, previously surgically treated, recurrent clubfoot and clubfoot not requiring tenotomy were not included in this study. Further, children who did not require tenotomy were also excluded. ANOVA regression analysis was used for finding correlation between initial Pirani score, age in months and number of corrective casts prior to tenotomy.
Results:
There were a total of 297 children (442 feet) in the study. The average age of the child at presentation was 10.3 months and the average initial Pirani score was 4.8. The average number of corrective casts was seven per child (range, two to18). The regression analysis showed both Pirani and age had positive correlation with number of casts, although weak (r2 = 0.05-0.20). The initial Pirani scoring correlated ten times more than age (in months) to the number of casts.
Conclusion:
The number of casts for correction in idiopathic clubfoot, although variable, is influenced by both initial Pirani score and age.
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