The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic
Sophie Moerman1, Nienke Zijlstra-Koenrades2, Max Reijman3
1Department of Children's Orthopaedics, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Insights
Predicting additional surgery for idiopathic clubfoot is crucial. Physical exams (Pirani score) and radiographs at three months effectively predict the need for further surgical intervention in Ponseti method treatment.
Area of Science:
- Pediatric Orthopedics
- Foot and Ankle Surgery
- Congenital Abnormalities
Background:
- Idiopathic clubfoot is a common congenital foot deformity.
- The Ponseti method is a widely used non-surgical treatment approach.
- Predicting the need for additional surgery after initial correction remains challenging.
Purpose of the Study:
- To evaluate the predictive value of the Pirani score and radiographic measurements at three months for future surgical intervention in idiopathic clubfeet treated with the Ponseti method.
- To assess the correlation between clinical and radiographic findings and the requirement for additional surgery.
- To investigate the impact of needing additional surgery on parent satisfaction.
Main Methods:
- Retrospective cohort study of 72 idiopathic clubfeet (50 children) treated with the Ponseti method.
- Pirani scores recorded at first cast, before tenotomy, and at three months.
- Radiographs taken at three months of age.
- Logistic regression analysis to correlate findings with the need for additional surgery.
- Follow-up of at least five years.
- Parent satisfaction assessed using a disease-specific instrument.
Main Results:
- Additional surgery was required in 38% (27/72) of cases.
- A larger lateral tibiocalcaneal angle and a smaller lateral talocalcaneal angle at three months correlated with increased need for surgery.
- Higher Pirani scores at both pre-tenotomy and three-month follow-up were associated with a greater likelihood of requiring additional surgery.
- Parent satisfaction was lower in children who underwent additional surgery.
Conclusions:
- Both the Pirani score and lateral radiographs at three months of age are valuable predictors of the need for future surgical intervention in idiopathic clubfeet treated with the Ponseti method.
- These tools can aid clinicians in identifying patients at higher risk for additional surgery.
- Early identification of high-risk cases may allow for timely intervention and potentially improve outcomes and parental satisfaction.
Abstract:
There are few validated predictors of the need for additional surgery in idiopathic clubfeet treated according to the Ponseti method. Our aim was to examine if physical examination (Pirani score) and radiographs at the age of three months (after initial correction of the clubfeet) can predict the future need for additional surgery. In this retrospective cohort study, radiographs of idiopathic clubfeet were made at the age of three months. The Pirani score was determined at the first cast, before tenotomy, and at the age of three months. Follow-up was at least five years. The correlation between the radiograph, Pirani score, and the need for additional surgery was explored with logistic regression analysis. Parent satisfaction was measured with a disease-specific instrument. The study included 72 clubfeet (50 children) treated according to the Ponseti method. Additional surgery was needed on 27 feet (38%). A larger lateral tibiocalcaneal angle (i.e., equinus) and a smaller lateral talocalcaneal angle (i.e., hindfoot varus) at the age of three months were correlated with the need for additional surgery. Higher Pirani scores before tenotomy and at the age of three months also correlated with additional surgery. Parent satisfaction was lower in patients who needed additional surgery. Both the Pirani scores and the lateral radiographs are predictive for future additional surgery.
