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. 2018 Nov;13(3):171-177.
doi: 10.1007/s11751-018-0324-z. Epub 2018 Nov 15.

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

T R Nunn  1 , M Etsub  2 , T Tilahun  2 , R O E Gardner  2 , V Allgar  3 , A M Wainwright  4 , C B D Lavy  4
Affiliations

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

T R Nunn et al. Strategies Trauma Limb Reconstr. 2018 Nov.

Abstract

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.

Keywords: Childhood; Clubfoot; Delayed presenting; Score.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was given to undertake this observational study which has therefore been performed in accordance with the pertinent ethical guidelines (i.e. Declaration of Helsinki, as laid down in 1964 and revised in 2008).

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.

Figures

Fig. 1
Fig. 1
Worked example. Gentle corrective force is applied whilst measuring the angles with a goniometer. To begin with this is best done using 2 people. Plantaris 25 degrees = 2 points, adductus 27 degrees = 2 points, varus 18 degrees = 1 point, equinus 72 degrees = 3 points, rotation around talar head 44 degrees = 2 points, P + A+V + E+R = 10 points. Child is 8 years old—multiplier = × 2. PAVER score is 2 × 10 = 20/30
Fig. 2
Fig. 2
Clinical picture of a right foot in an 11-year-old. The midfoot correction was achieved following 9 casts. Equinus correction was achieved after a percutaneous Achilles tendon lengthening followed by a cast wedge. This illustration shows cuboid prominence (a) and the post-surgical appearance (b) following tibialis anterior tendon transfer to the lateral cuneiform with additional cuboid decancellation performed
Fig. 3
Fig. 3
Schematic diagram of the score elements and the final calculation
Fig. 4
Fig. 4
PAVER scores according to success or failure of casting
See this image and copyright information in PMC

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