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Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for

T R Nunn1, M Etsub2, T Tilahun2

  • 1CURE Ethiopia Children's Hospital, Addis Ababa, Ethiopia. tim.nunn@cureinternational.org.

Strategies in Trauma and Limb Reconstruction
|November 17, 2018
PubMed

Insights

A new clinical scoring system, PAVER, accurately predicts clubfoot treatment response to Ponseti casting in children. This simple, reliable tool aids in prognosis and treatment planning for delayed presenting clubfeet.

Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Clinical Assessment

Background:

  • Clubfoot is a common congenital foot deformity.
  • Delayed presenting clubfeet require reliable assessment tools for effective treatment.
  • Existing scoring systems may not fully capture the complexity of delayed presentations.

Purpose of the Study:

  • To develop a novel, simple, and reliable clinical scoring system for delayed presenting clubfeet.
  • To assess the predictive capability of this new score for response to Ponseti casting.
  • To identify key clinical measurements that best represent clubfoot severity in children aged 2-10 years.

Main Methods:

  • A novel scoring system, PAVER (plantaris, adductus, varus, equinus of the ankle, and rotation around the talar head), was developed.
  • Inter-observer and intra-observer reliability were assessed using 4 assessors on 42 feet.
  • The PAVER score was prospectively validated on 100 clubfeet, correlating with the number of casts needed for correction.

Main Results:

  • The PAVER score demonstrated high inter-observer and intra-observer agreement.
  • The PAVER score showed a strong association with the total number of casts required for full correction (tau = 0.71).
  • A PAVER score greater than 18 out of 30 indicated a cast-resistant clubfoot.

Conclusions:

  • The PAVER score is a simple, reliable, and effective tool for assessing delayed presenting clubfeet.
  • This score can predict treatment response to Ponseti casting, aiding clinical decision-making.
  • PAVER facilitates prognosis, treatment planning, and research comparison of clubfoot severity.

Keywords:
ChildhoodClubfootDelayed presentingScore

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