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Predictive Measurement for Windlass Change in Length and Selected Treatment Outcomes in Chronic Plantar Fasciitis
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Subgroups of Idiopathic Clubfoot Can Predict Short-term Outcomes.

Rachal Quinlan1, Verity Pacey1, Emre Ilhan1,2

  • 1Macquarie University.

Journal of Pediatric Orthopedics
|March 13, 2023
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Summary

Four subgroups of idiopathic clubfoot were identified based on Pirani scale scores. Subgrouping helps predict outcomes and the need for tenotomy in Ponseti-managed clubfoot patients.

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Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Podiatry

Background:

  • The Pirani scale assesses Ponseti-managed clubfoot, but predicting outcomes using the total score is inconsistent.
  • The prognostic value of the midfoot and hindfoot components of the Pirani scale is not well understood.

Purpose of the Study:

  • To identify subgroups of Ponseti-managed idiopathic clubfoot based on midfoot and hindfoot Pirani scale score trajectories.
  • To determine when these subgroups can be distinguished during treatment.
  • To assess if these subgroups correlate with the number of casts needed and the requirement for Achilles tenotomy.

Main Methods:

  • Group-based trajectory modeling was used on Pirani scale midfoot and hindfoot scores from 226 children (335 idiopathic clubfeet) over 12 years.
  • Generalized estimating equations identified time points for subgroup distinction.
  • Kruskal-Wallis and binary logistic regression analyzed cast numbers and tenotomy rates.

Main Results:

  • Four subgroups were identified: fast-steady (61%), steady-steady (19%), fast-nil (7%), and steady-nil (14%).
  • Subgroups could be distinguished by the second or fourth cast removal.
  • While statistically significant, the median number of casts (5-6) showed minimal clinical difference across groups. Tenotomy rates varied significantly between subgroups.

Conclusions:

  • Four distinct subgroups of idiopathic clubfoot exist based on Pirani scale score changes.
  • Subgroup identification offers clinical value in predicting outcomes, particularly tenotomy rates, for Ponseti-managed clubfoot.