Pirani Score – CTEV
Pirani Score is composed of 10 different physical examination findings used in classification of Congenital Talipes Equino Varus (CTEV) or clubfoot deformity.
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 Findings | 0 | 0.5 | 1 |
---|---|---|---|
Curvature of lateral border of foot | Straight | Mild distal curve | Curve at calcaneocuboid joint |
Severity of medial crease (foot held in maximal correction) | Multiple fine creases | One or two deep creases | Deep creases change contour of arch |
Severity of posterior crease (foot held in maximal correction) | Multiple fine creases | One or two deep creases | Deep creases change contour of arch |
Medial malleolar-navicular interval (foot held in maximal correction) | Definite depression felt | Interval reduced | Interval not palpable |
Palpation of lateral part of head of talus (forefoot fully abducted) | Navicular completely “reduces”; lateral talar head cannot be felt | Navicular partially “reduces”; lateral head less palpable | Navicular does not “reduce”; lateral talar head easily felt |
Emptiness of heel (foot and ankle in maximal correction) | Tuberosity of calcaneus easily palpable | Tuberosity of calcaneus more difficult to palpate | Tuberosity of calcaneus not palpable |
Fibula-Achilles interval (hip flexed, knee extended, foot and ankle maximally corrected) | Definite depression felt | Interval reduced | Interval not palpable |
Rigidity of equines (knee extended, ankle maximally corrected) | Normal ankle dorsiflexion | Ankle dorsiflexes beyond neutral, but not fully | Cannot dorsiflex ankle to neutral |
Rigidity of adductus (forefoot is fully abducted) | Forefoot can be overcorrected into abduction | Forefoot can be corrected beyond neutral, but not fully | Forefoot cannot be corrected to neutral |
Long flexor contracture (foot and ankle held in maximal correction) | MTP joints can be dorsiflexed to 90 degrees | MTP joints can be dorsiflexed beyond neutral but not fully | MTP joints cannot be dorsiflexed to neutral |
In a study to evaluate the hind foot score of Pirani score system in treatment of congenital talipes equinovarus by Ponseti method, they Pirani score system use to predict the need for tenotomy. They found that initial rigidity of equinus and severity of posterior crease of hindfoot score of the Pirani scoring system help in predicting the need for tenotomy later.
References
- 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. Pubmed
- 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.
- 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. Pubmed
- ResearchGate – Evaluation of hind foot score of Pirani scoring system in treatment of congenital talipes equinovarus by Ponseti method
- Campbel’s Operative Orthopaedics 12th edition Book.
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