An independent assessment of two clubfoot-classification systems

Abstract

We conducted an independent assessment of two clubfoot-classification systems. In a blinded trial, two orthopaedists scored 55 feet by using the classification systems developed by Pirani et al. and by Dimeglio et al. Thirty-seven of the feet were also scored by a physical therapist. By using the 10-point classification described by Pirani, the two physician examiners tallied total scores that were within one point of one another 89% of the time. The mean difference between the scores assigned by the two examiners was 0.6 points. For the 20-point classification described by Dimeglio et al., total scores tallied by the two physician examiners were within two points of one another 91% of the time. The mean difference between the scores assigned by the two physician examiners was 1.4 points. Correlation coefficients were 0.90 (p = 0.0001) for the Pirani classification, and 0.83 (p = 0.0001) for the Dimeglio classification. Correlation coefficients were much lower for the first 15 feet scored and were also lower when the therapist's scores were included. Overall, both classification systems had very good interobserver reliability after the initial learning phase.