Khan Mansoor Ali, Chinoy Muhammad Amin, Moosa Rida, Ahmed Syed Kamran
Department of Orthopaedics The Indus Hospital.
Iowa Orthop J. 2017;37:151-156.
The aim of clubfoot treatment by Ponseti method is to achieve a corrected foot, with at least 15° dorsiflexion and 70° abduction, and fit comfortably into a brace at the recommended setting. This study aimed to acknowledge the validity and reliability of the Pirani scoring system, while investigating if a corrected clubfoot has a Pirani score of zero. The study hypothesized that a corrected clubfoot may or may not have a Pirani score of zero.
706 patients with clubfoot were treated by Ponseti's method of weekly manipulations and casting, from November 2011 to May 2016, at a tertiary care hospital, making a total of 1055 feet. All data was entered into the International Clubfoot Network Database, along with Pirani scoring. Tenotomy was performed in eligible patients.
The mean Pirani score at the end of treatment phase of casting and initiation of the maintenance phase of bracing for the right foot was 1.1 (SD=0.55) and left foot was 1.2 (SD=0.58). These feet not only fit the criteria of a corrected clubfoot, 70° abduction and 15° dorsiflexion, but also fit well in a foot abduction brace. Of the 1055 diagnosed Clubfeet, 643 required tenotomy (60.9%).
The study shows that the affected foot does not need to have a Pirani score of zero to be considered a corrected foot. Pirani score is an excellent tool used over the years to evaluate clubfoot. Pirani score does not assess adequately the transition from the treatment phase of casting to the maintenance phase of bracing. The use of the International Clubfoot Database-Treatment visit form, including all components of clubfoot and the Pirani score, provides a clear understanding of whether the patient has achieved foot correction or not. .
庞塞蒂方法治疗马蹄内翻足的目的是使足部得到矫正，背屈至少15°，外展70°，并能舒适地适配于推荐设置的支具。本研究旨在确认皮拉尼评分系统的有效性和可靠性，同时调查矫正后的马蹄内翻足皮拉尼评分是否为零。该研究假设矫正后的马蹄内翻足皮拉尼评分可能为零，也可能不为零。
2011年11月至2016年5月，在一家三级护理医院，706例马蹄内翻足患者接受了庞塞蒂每周手法治疗和石膏固定方法，共计1055只脚。所有数据以及皮拉尼评分均录入国际马蹄内翻足网络数据库。符合条件的患者接受了跟腱切断术。
在石膏固定治疗阶段结束和开始支具维持阶段时，右脚的平均皮拉尼评分为1.1（标准差=0.55），左脚为1.2（标准差=0.58）。这些足部不仅符合矫正马蹄内翻足的标准，即外展70°和背屈15°，而且能很好地适配足部外展支具。在1055例诊断为马蹄内翻足的病例中，643例需要进行跟腱切断术（60.9%）。
该研究表明，患足皮拉尼评分不为零也可被视为矫正足。多年来，皮拉尼评分一直是评估马蹄内翻足的优秀工具。皮拉尼评分不能充分评估从石膏固定治疗阶段到支具维持阶段的过渡情况。使用国际马蹄内翻足数据库-治疗访视表，包括马蹄内翻足的所有组成部分和皮拉尼评分，能清楚了解患者是否实现了足部矫正。
