Analysis of Correlation of Foot Bimalleolar Angle and Pirani Scoring for its Predictive value in the management of Idiopathic CTEV by Ponseti Method

摘要

BACKGROUND- This study was conducted with the aim to study Foot bimalleolar angle (FBA) and Pirani scoring with emphasis on analysis of their correlation for its predictive value in the management of clubfeet managed by Ponseti technique.METHOD & MATERIAL- Total 30 subjects (42 feet) were studied, which were corrected by Ponseti technique. All were evaluated clinically, radiologically, podogrammically and by Catteral Pirani Scoring System, both before and after the correction. RESULTS- Severity of the deformities and clinical correction was assessed by Pirani score. All patients achieved good clinical results as per Pirani score, which was statistically significant. Radiological evaluation showed that all subject achieved the normal range of values. The pre and post correction difference in FBA was statistically significant. CONCLUSION- Foot Bimalleolar Angle proved as one of the indicator of severity of deformity in CTEV, which corresponds with other clinico-radiological parameters. The correlation between FBA and Pirani was found significant, predictive and reproducible. Introduction The CTEV, a hereditary foot deformity is one of the commonest congenital foot anomalies presenting to a paediatric orthopaedic surgeon. Its incidence is 5-6 per 1000 live births, varying with race and geography 1 . Males are more commonly affected in the ratio of 3:1. Bilateral presentation of this deformity is there in more than 40 percent of cases. All clubfeet are not the same. There is a spectrum of deformity ranging from the newborn positional deformity (which usually corrects with one or two casts) to the stiff callused foot of the adolescent whose deformed foot has never been treated. The goal of any type of CTEV management is to reduce, if not to eliminate all elements of the clubfoot deformity. Hence achieving a functional, pain free, normal looking plantigrade, mobile, callous free and normally shoeable foot 2 . The various factors that have been associated with the poor prognosis in CTEV management are female child, hereditary, late age of presentation, severity of deformity, rigidity of foot, associated cavus, associated clawing of toes and small heel 3 . Kite 4 rationaled the whole treatment of clubfoot by conservative means and his technique of manipulation and casting remained popular among orthopaedic surgeons for last many decades with satisfactory to good results. Recently, various workers have shown satisfactory results by Ponseti 5 method of manipulation and serial casting. This technique offers correction of all components of deformity in shortest duration with less incidences of recurrence. Ponseti considered head of talus as the center of all the components of this deformity. Recently an association of internal talar spin and varus component of this deformity has been established 6 . Clinically the talar spin can be measured by Foot bimalleolar axis 7 . This study was conducted to evaluate the clinico-radiological outcomes of CTEV managed by Ponseti method with special emphasis on the evaluation of bimalleolar angle in these patients. Material and Method This observational study was conducted on all the patients of 0-2 years of age since July 2003 to January 2005. All patients were managed on OPD basis.