Although Dimeglio and Pirani scores are frequently employed to rate the severities of clubfoot and to evaluate treatment outcomes, it is unclear if these scores predict relapse after treatment. Ankle dorsiflexion has been suggested in recent years to be a promising predictor of relapse. The aim of this study was to investigate ankle dorsiflexion and Dimeglio and Pirani scores in predicting the relapse of clubfoot after treatment with the Ponseti method. We included patients with clubfoot previously treated by the Ponseti method, and retrospectively analyzed their initial ankle dorsiflexion, Pirani and Dimeglio scores, number of castings, and the occurrence of relapse. We analyzed 218 feet of 176 infants with clubfoot who showed an incidence of relapse of 17.0% (30/176). The mean initial Pirani and Dimeglio scores of the feet showing recurrence were significantly higher than individuals with non-recurrence (p < .001 each). We observed a robust association between Pirani and Dimeglio scores and the recurrence of clubfoot at the last follow-up (γ = 0.53, p = .001). In contrast, ankle dorsiflexion was negatively correlated with recurrence of clubfoot (γ = -0.21, p = .001). Dimeglio scores significantly predicted the recurrence of clubfoot (p = .014). Receiver operating characteristic curve analysis exhibited slightly better performance regarding the Dimeglio score relative to the Pirani score and ankle dorsiflexion in predicting recurrence. Ankle dorsiflexion and Pirani and Dimeglio scores were related to recurrence in patients with clubfoot. However, the Dimeglio score reflected superior accuracy in predicting the prognosis of clubfoot treated with the Ponseti method.
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis.Trop Med Int Health. 2017; 22: 269-285
- Current conservative management and classification of clubfoot: a review.J Pediatr Rehabil Med. 2016; 9: 257-264
- The role of the Pirani scoring system in the management of clubfoot by the Ponseti method.J Bone Joint Surg Br. 2006; 88: 1082-1084
- A clinical evaluation of the Pirani and Dimeglio idiopathic clubfoot classifications.J Foot Ankle Surg. 2015; 54: 582-585
- Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique.Instr Course Lect. 2006; 55: 625-629
- Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children.Acta Orthop. 2018; 89: 448-453
- Relapse following use of Ponseti method in idiopathic clubfoot.J Child Orthop. 2018; 12: 1-9
- Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet.J Bone Joint Surgery Am. 2004; 86: 22-27
- The correlation of Pirani and Dimeglio scoring systems for Ponseti management at different levels of deformity severity.Sci Rep. 2017; 7: 14578
- Worldwide spread of the Ponseti method for clubfoot.World J Orthop. 2014; 5: 585-590
- Dimeglio score predicts treatment difficulty during Ponseti casting for isolated clubfoot.J Pediatr Orthop. 2019; 39: e402-e4e5
- Prediction of number of casts and need of tenotomy using Pirani score in the management of clubfoot.J Craniofac Surg. 2019; 30: e477-ee81
- Classification of clubfoot.J Pediatr Orthop B. 1995; 4: 129-136
- The Ponseti technique and improved ankle dorsiflexion in children with relapsed clubfoot: a retrospective data analysis.J Pediatr Orthop B. 2017; 26: 116-121
- Relapsing clubfoot: causes, prevention, and treatment.Iowa Orthop J. 2002; 22: 55-56
- A retrospective study of idiopathic clubfoot managed by Ponseti method using Pirani and Dimeglio scoring, in Indian population: a minimum 3-year follow-up.J Pediatr Orthop B. 2021; 30: 71-79
- Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method.Int Orthop. 2018; 42: 2429-2436
- Narrative review of the management of a relapsed clubfoot.Ann Transl Med. 2021; 9: 1102
- How to calculate sample size for different study designs in medical research?.Indian J Psychol Med. 2013; 35: 121-126
- Influence of age, weight, and Pirani score on the number of castings in the early phase of clubfoot treatment using Ponseti method.Malays J Med Sci. 2014; 21: 40-43
- Subjective and objective outcome in congenital clubfoot; a comparative study of 204 children.BMC Musculoskelet Disord. 2007; 8: 53
- Assessment of late results of surgery in talipes equino-varus: a reliability study.Eur J Pediatr. 1997; 156: 317-319
- Early clubfoot recurrence after use of the Ponseti method in a New Zealand population.J Bone Joint Surg Am. 2007; 89: 487-493
- Factors associated with recurrence of clubfoot treated by the Ponseti method.World J Clin Cases. 2016; 4: 318-322
- Factors affecting outcome after the use of the Ponseti method for the management of idiopathic clubfoot, a retrospective study in an orthopaedic referral institute.Acta Orthop Belg. 2016; 82: 705-709
- Positive communication paradigm decreases early recurrence in clubfoot treatment.J Pediatr Orthop. 2014; 34: 219-222
Published online: June 30, 2022
Financial Disclosure: The authors declare that they have no financial interests/personal relationships which may be considered as potential competing interests.
Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.