Aim: To determine the value of the Pirani clubfoot-scoring system at initial presentation in predicting subsequent relapse.
Method: All clubfoot patients treated by one surgeon from 2002 to 2006 were included. Treatment followed the standard protocol, involving weekly stretching and casting until the foot was corrected, followed by Achilles tenotomy and plasters for 3 weeks. Thereafter, the child was placed in a foot abduction splint.
Relapses within 6 months of instigating the foot abduction splint were classed as early and subsequent relapses as late.
The severity of clubfoot was assessed using the Pirani scoring system which comprises two sub-scores – Midfoot Contracture Score (MFCS) and Hindfoot Contracture Score (HFCS). MFCS and HFCS can each be 0.0–3.0, giving rise to a Total Pirani Score (TPS) of 0.0–6.0.
Results: Sixty-one clubfoot patients were treated, with five lost to the follow-up. A total of 89 clubfeet were treated. There were 3 early and 19 late relapses. The average interval between initiating the foot abduction splint and late relapse was 23 months. TPS median was 4.5 in the no relapse group, 4.0 in the early relapse group, and 5.0 in the late relapse group. MFCS median was 2.0 in the no relapse group, 2.0 in the early relapse group, and 2.0 in late relapse group. HFCS median was 2.5 in the no relapse group, 2.5 in the early relapse group, and 3.0 in the late relapse group. Higher HFCS was statistically significant when comparing the late and no relapse groups (p<0.05, 95% CI −0.5–0.0).
Conclusions: Higher Pirani scores were associated with late relapses, but HFCS is a stronger predictor of potential late relapse. Close follow-up is advised for patients at risk.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.