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Pirani Score - Clubfoot Deformity

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Pirani Score – Clubfoot Deformity

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Pirani Score is composed of 10 different physical examination findings used in classification of the clubfoot deformity. It was developed by Shafique Pirani MD.

The Pirani score demonstrates its importance with regards to assessing the severity of clubfoot, mainly at presentation and for monitoring patient’s progress.

The Pirani score system works by assessing six clinical signs of contracture, which may score 0 (no deformity), 0.5 (moderate deformity) or 1(severe deformity). Each foot is assigned a total score, the maximum being 10 points, with a higher score indicating a more severe deformity.

The Pirani score for clubfoot is reliable, quick, and easy to use, and provides a good forecast about the likely treatment for an individual foot but a low score does not exclude the possibility that a tenotomy may be required.

See Also: Metatarsus Adductus

Pirani Score System

Physical Examination Findings00.51
Curvature of lateral border of footStraightMild distal curveCurve at calcaneocuboid joint
Severity of medial crease (foot held in maximal correction)Multiple fine creasesOne or two deep creasesDeep creases change contour of arch
Severity of posterior crease (foot held in maximal correction)Multiple fine creasesOne or two deep creasesDeep creases change contour of arch
Medial malleolar-navicular interval (foot held in maximal correction)Definite depression feltInterval reducedInterval not palpable
Palpation of lateral part of head of talus (forefoot fully abducted)Navicular completely “reduces”; lateral talar head cannot be feltNavicular partially “reduces”; lateral head less palpableNavicular does not “reduce”; lateral talar head easily felt
Emptiness of heel (foot and ankle in maximal correction)Tuberosity of calcaneus easily palpableTuberosity of calcaneus more difficult to palpateTuberosity of calcaneus not palpable
Fibula-Achilles interval (hip flexed, knee extended, foot and ankle maximally corrected)Definite depression feltInterval reducedInterval not palpable
Rigidity of equines (knee extended, ankle maximally corrected)Normal ankle dorsiflexionAnkle dorsiflexes beyond neutral, but not fullyCannot dorsiflex ankle to neutral
Rigidity of adductus (forefoot is fully abducted)Forefoot can be overcorrected into abductionForefoot can be corrected beyond neutral, but not fullyForefoot cannot be corrected to neutral
Long flexor contracture (foot and ankle held in maximal correction)MTP joints can be dorsiflexed to 90 degreesMTP joints can be dorsiflexed beyond neutral but not fullyMTP joints cannot be dorsiflexed to neutral
Pirani Score system
Emptiness of heel (foot and ankle in maximal correction)
Pirani Score system
Palpation of lateral part of head of talus (forefoot fully abducted)
Pirani Score system
Rigidity of equines (knee extended, ankle maximally corrected)
Pirani Score system
Curvature of lateral border of foot – Severity of medial crease (foot held in maximal correction) – Severity of posterior crease (foot held in maximal correction)

References

  1. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006 Aug;88(8):1082-4. doi: 10.1302/0301-620X.88B8.17482. PMID: 16877610.
  2. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop. 1998 May-Jun;18(3):323-7. PMID: 9600557.
  3. Khan MA, Chinoy MA, Moosa R, Ahmed SK. Significance Of Pirani Score at Bracing-Implications for Recognizing A Corrected Clubfoot. Iowa Orthop J. 2017;37:151-156. PMID: 28852350; PMCID: PMC5508266.
  4. Campbel’s Operative Orthopaedics 12th edition Book.
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