The Ponseti method

2. Pirani scoring

Contents

• Pirani scoring

• Hindfoot contracture score

• Midfoot contracture score

• Recording Pirani scores

• Application of scoring

• Case Example

Assessment of the Untreated Clubfoot & measuring how it responds to treatment: The Columbian (Pirani)

Clubfoot Score: a simple way to measure a clubfoot

• Signs scored 0, 0.5, or 1

– Hindfoot Contracture Score (HFCS) 0-3• Equinus

• Deep Posterior Crease

• Empty Heel

– Midfoot Contracture Score (MFCS) 0-3• Curved Lateral Border

• Medial Crease

• Lateral Head of Talus

– Total Score (TS) 0-6

0.5

0

1.0

Hindfoot contracture: Posterior Crease

Score 0 Score 0.5 Score 1

Hindfoot contracture: Empty Heel

Score 0Score 1

Hindfoot contracture: Rigid Equinus

Score 0 Score 1Score 0.5

Signs for Midfoot Contracture Score: Curved Lateral Border

Score 0 Score 1Score 0.5

Midfoot Contracture: Medial Crease

Score 0 Score 1Score 0.5

Midfoot Contracture: Lateral Head of Talus

Score 0 Score 1Score 0.5

UNTREATED CLUBFOOT ASSESSMENT AND TREATMENT RECORD

i. Demographics Date of Initial Exa m:

Name: Sex: F M DOB:

Address: Town:

District: Clinic Name:

Mother’s Name:: Telephone :

Fathers Name: Tribe:

Orth Officer/Physio: Birth Attendant:

Place of Birth Hosp ( ) Clinic ( ) Home ( )

ii. History

Pregnancy:

Delivery:

Post Delivery:

Family History:

Treatment to Date:

Examination

Spine :

Hips:

Up extrem:

Low extrem:

Other:

Medical Record Number

Research Number

Additional Notes/Details

The Ponseti Method

HFCS = 3 MFCS = 2.5

Ponseti Casting

HFCS = 2.5 MFCS = 0.5

Tenotomy

The Ponseti Method: tenotomy & final cast

• The Columbian clubfoot score indicates when thefoot is ready for a tenotomy

– MFCS is one or less & HFCS more than one

– LHT = 0

– Heel in valgus

KK:Scores at start of Ponseti Treatment

Curved Lat Border 1

Medial Crease 0.5

Lat Head Talus 1

MFCS 2.5

Post Crease 1.0

Empty Heel 1.0

Rigid Equinus 1.0

HFCS 3.0

TS 5.5

Clubfoot scores with Ponseti Treatment

KK:Scores after correction of abduction, before TA tenotomy

Curved Lat Border 0

Medial Crease 0

Lat Head Talus 0

MFCS 0

Post Crease 0.5

Empty Heel 1.0

Rigid Equinus 1.0

HFCS 2.5

TS 2.5

Clubfoot scores with Ponseti Treatment

KK: Scores after correction of abduction, and TA tenotomy

Curved Lat Border 0

Medial Crease 0

Lat Head Talus 0

MFCS 0

Post Crease 0.5

Empty Heel 0.5

Rigid Equinus 0

HFCS 1.0

TS 1.0

Clubfoot scores with Ponseti Treatment

KK: Clubfoot Scores with Ponseti Treatment

0

1

2

3

4

5

6

Week 1 Week 2 Week 3 Week 4 Wk 5-

tenotomy

Wk 5+ten

Weeks of Treatment

Score HFCS

MFCS

TS