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Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study. J Pediatr Orthop 2023; 43:174-176. [PMID: 36728662 DOI: 10.1097/bpo.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents of children with clubfoot are likely to inquire about the need for tenotomy and about any factors that may be predictive. The present study was done to identify factors that may help predict the need for tenotomy in children undergoing Ponseti treatment for idiopathic clubfoot. METHODS A prospective observational study was conducted on patients under 5 years of age with idiopathic clubfoot and no previous treatment history treated at Hospital and Rehabilitation Centre for Disabled Children. The relationship between the Pirani score, Dimeglio score, age, and passive ankle dorsiflexion (DF) and the need for heel cord tenotomy was analyzed using appropriate statistical methods. RESULTS Of 83 patients (125 feet) with a mean age of 6 months, 93 feet (74.4%) required a percutaneous tenotomy. The mean initial Pirani and Dimeglio score for 125 club feet was 4.5 (SD=1.68) and 13.5 (SD=6.1), respectively. The mean initial passive ankle DF was -40.4 (SD=22.31). The Dimeglio ( P =0.000), Pirani scores ( P =0 .000), and passive ankle DF ( P =0.000) showed significant association with the need for tenotomy. CONCLUSIONS This study shows a strong association between initial Pirani and Demiglio scores and initial passive ankle DF as predictive of a heel cord tenotomy. However, age, sex, and laterality were not associated with the need for tenotomy.
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Fantasia I, Dibello D, Di Carlo V, Colin G, Barbieri M, Belcaro C, Magni E, Faletra F, Laura T, Stampalija T. Prenatal diagnosis of isolated clubfoot: Diagnostic accuracy and long-term postnatal outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 264:60-64. [PMID: 34273754 DOI: 10.1016/j.ejogrb.2021.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery and postnatal outcomes in relation to the prenatal classification of severity. STUDY DESIGN This is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV between 2004 and 2018. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed-up postnatally for at least two years, with a specific focus on neurodevelopmental outcome. RESULTS The cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases. Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity (k = 0.61 and 0.66, respectively). The average Pirani score, number of casts and rates of Achilles tendon tenotomy were higher for III degree cTEV (p < 0.001). Within this group only, the rate of relapse was 11% and the rates of major surgery was 6%. The postnatal outcome was normal in 68.6% newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development. None of the outcome was statistically correlated to the prenatal assessment of laterality or degree. CONCLUSIONS The accuracy of prenatal ultrasound for isolated cTEV is 86% with a false positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of number of casts and need of surgery. The assessment of the correlation between cTEV and neurological impairment requires further prospective studies on larger cohorts.
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Affiliation(s)
- Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
| | - Daniela Dibello
- Unit of Orthopedics and Traumatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Valentina Di Carlo
- Unit of Orthopedics and Traumatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Giulia Colin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Moira Barbieri
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Chiara Belcaro
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Elena Magni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 34137 Trieste, Italy
| | - Flavio Faletra
- Department of Medical Genetics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Travan Laura
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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El Hadi MH, Nurein MA, Bader MAES, Salih MMA, Babikir HE. Radiological study of anatomical bony arrangement of the clubfoot deformity and its correlation with the Pirani clinical scoring system: A multicenter study. Sudan J Paediatr 2019; 19:101-109. [PMID: 31969738 DOI: 10.24911/sjp.106-1573461977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Club foot or congenital talipes equinovarus (CTEV) is a common developmental disorder of the foot, affecting 1 per 1,000 live births. The main goal of this study is to evaluate the anatomical bony arrangement of the clubfoot deformity radiologically and to correlate this arrangement with the Pirani clinical scoring system. This descriptive, analytical study was conducted in three centres in Sudan. It recruited all the patients of both sexes with CTEV attending these centres, and excluding children on conservative cast and those who already had surgery. Data were collected using structured questionnaire. Pirani clinical scoring system, a reliable clinical assessment method, was applied. Four angles were used to measure each component of the deformity and correlate this with the Pirani score. Feet radiology was performed to assess the bone anatomy. The index cases number was 25 with male-to-female ratio of 1.6:1. Both feet were involved simultaneously in about half of the cases. Only the dorsoplanter (DP) and lateral (L) views talo-1st metatarsal angle was used to describe the forefoot adduction and mid-foot cavus, respectively. These correlated significantly with the clinical score of Pinari, whereas the other two measures for the equinus and varus did not. The results matched with the demographic description of the deformity found in the literature. Further studies are warranted that combine both the clinical assessment and the X-ray measurements in one score to classify the severity of the deformity and guide the management options.
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Affiliation(s)
| | | | | | | | - Haydar Elhadi Babikir
- Department of Paediatrics and Child Health, Faculty of Medicine University of Gezira, Wad Medani, Sudan
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Lampasi M, Abati CN, Bettuzzi C, Stilli S, Trisolino G. Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method. INTERNATIONAL ORTHOPAEDICS 2018; 42:2429-2436. [PMID: 29594373 DOI: 10.1007/s00264-018-3873-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/28/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE The Dimeglio and the Pirani scores are largely used to rate clubfoot at presentation and monitor correction. To date, the accuracy of these scores in predicting appropriate treatment is controversial. The aim of this study was to investigate the accuracy of Dimeglio and Pirani scores in predicting the number of casts and the need for tenotomy in clubfoot correction using the Ponseti method. METHODS Ninety-one consecutive feet (54 patients; mean age at presentation: 28 ± 15 days) undergoing clubfoot correction using the Ponseti method were prospectively followed from first casting to correction. All feet were scored according to the Dimeglio and Pirani score. The relationships between the two scores, the number of casts and the need for tenotomy were analysed. RESULTS Initial correction was achieved in all feet. Both Dimeglio (r = .73; p value < .0005) and Pirani scores (r = .56; p value < .000) showed good association with the number of casts. Multiple linear regression showed a high collinearity of the two scores but a more significant contribution of the Dimeglio score. Among subcomponents, hindfoot score, midfoot score, varus and muscular abnormality were independent predictors of the number of casts. Both Dimeglio and Pirani scores were significantly associated with the need for tenotomy (p value = .0000), and odds ratios and cut-off points were calculated. The receiving operator curve (ROC) analysis showed slightly better performance of the Dimeglio in comparison with the Pirani score in predicting the need for tenotomy, but the difference between the two areas under the curve (AUC) was not significant (p = .48). CONCLUSIONS A quite accurate prediction of the number of casts and the need for tenotomy can be performed in most cases. The Dimeglio score showed slightly better accuracy in predicting both steps of Ponseti treatment.
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Affiliation(s)
- Manuele Lampasi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Caterina Novella Abati
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Camilla Bettuzzi
- Department of Paediatric Orthopaedics and Traumatology, Anna Meyer Children's Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Stefano Stilli
- Department of Paediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Trisolino
- Department of Paediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
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Stone P, Martis W, Crawford H. Idiopathic congenital talipes equinovarus; not always an isolated anomaly. A review of long-term outcomes. J Matern Fetal Neonatal Med 2017; 31:2693-2698. [DOI: 10.1080/14767058.2017.1353967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Grafton, New Zealand
| | - Walston Martis
- Department of Obstetrics and Gynaecology, University of Auckland, Grafton, New Zealand
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