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VOLUME 13 , ISSUE 3 ( November, 2018 ) > List of Articles

Original Article

Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2–10

Timothy R Nunn, M. Etsub, T. Tilahun, R. O. E. Gardner, V. Allgar, A. M. Wainwright, C. B. D. Lavy

Keywords : Clubfoot, Childhood, Delayed presenting, Score

Citation Information : Nunn TR, Etsub M, Tilahun T, Gardner RO, Allgar V, Wainwright AM, Lavy CB. Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2–10. 2018; 13 (3):171-177.

DOI: 10.1007/s11751-018-0324-z

License: CC BY-NC-SA 4.0

Published Online: 01-12-2016

Copyright Statement:  Copyright © 2018; The Author(s).


The aim of the study was to develop a simple and reliable clinical scoring system for delayed presenting clubfeet and assess how this score predicts the response to Ponseti casting. We measured all elements of the Diméglio and the Pirani scoring systems. To determine which aspects were useful in assessing children with delayed presenting clubfeet, 4 assessors examined 42 feet (28 patients) between the ages of 2–10 years. Selected variables demonstrating good agreement were combined to make a novel score and were assessed prospectively on a separate consecutive cohort of children with clubfeet aged 2–10, comprising 100 clubfeet (64 patients). Inter-observer and intra-observer agreement was found to be greatest using the following clinically measured angles of the deformities. These were plantaris, adductus, varus, equinus of the ankle and rotation around the talar head in the frontal plane (PAVER). Measured angles of 1–20, 21–45 and > 45 degrees scored 1, 2 and 3 points, respectively. The PAVER score was derived from both the sum of points derived from measured angles and a multiplier according to age. The sum of the points was multiplied with 1, 1.5 or 2 for ages 2–4, 5–7 and 8–10, respectively. This demonstrated a good association with the total number of casts to achieve a full correction (tau = 0.71). A score greater than 18 out of 30 indicated a cast-resistant clubfoot. The score could be used clinically for prognosis and treatment, and for research purposes to compare the severity of clubfoot deformities.

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  1. Penny JN (2005) The delayed presenting clubfoot. Tech Orthop 20(2):153-166
  2. Mkandawire NC, Kaunda E (2004) Incidence and patterns of congenital talipes equinovarus (clubfoot) deformity at Queen Elizabeth Central Hospital, Blantyre, Malawi. East Cent Afr J Surg 9(2):28-31
  3. Alavi Y, Jumbe V, Hartley S, Smith S, Lamping D, Muhit M, Masiye F, Lavy C (2012) Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawi. Disabil Rehabil 34(20):1736-1746
  4. Lohan I (2016) Treatment of congenital clubfoot using the Ponseti method. Accessed 24 Dec 2016
  5. Foster A, Davis N (2007) Congenital talipes equinovarus (clubfoot). Surgery (Oxford) 25(4):171-175
  6. Ayana B, Klungsøyr PJ (2014) Good results after Ponseti treatment for delayed presenting congenital clubfoot in Ethiopia. A prospective study of 22 children (32 feet) from 2 to 10 years of age. Acta Orthop 85(6):641-645
  7. Pirani S, Outerbridge HK, Sawatzky B, Stothers K (1999) A reliable method of clinically evaluating a virgin clubfoot evaluation. In: 21st SICOT congres
  8. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop B 4:129-136
  9. Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284-290
  10. Dietz FR, Tyler MC, Leary KS, Damiano PC (2009) Evaluation of a disease-specific instrument for idiopathic clubfoot outcome. Clin Orthop Relat Res 467(5):1256-1262
  11. Evans AM, Perveen R, Ford-Powell VA, Barker S (2014) The Bangla clubfoot tool: a repeatability study. J Foot Ankle Res 7:27
  12. Grimes CE, Holmer H, Maraka J, Ayana B, Hansen L (2016) Cost-effectiveness of clubfoot treatment in low-income and middle-income countries by the Ponseti method. BMJ Glob Health 1:e000023. (Accessed 12 Dec 2016)
  13. Sinclair MF, Bosch K, Rosenbaum D, Böhm S (2009) Pedobarographic analysis following Ponseti treatment for congenital clubfoot. Clin Orthop Relat Res 467(5):1223-1230
  14. Bleck EE (1987) Spastic hemiplegia. In: Bleck EE (ed) Orthopaedic management in cerebral palsy. Mac Keith Press, London
  15. Mehtani A, Prakash J, Vijay V, Kumar N, Sinha A (2017) Modified Ponseti technique for management of delayed presenting clubfeet. J Pediatr Orthop B.
  16. Lourenco AF, Morcuende JA (2007) Correction of delayed presenting idiopathic club foot by the Ponseti method. JBJS 89-B:378-381
  17. Spiegel DA, Shrestha OP, Banskota AK (2009) Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orth Relat Res 467(5):1164-1170
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