The Ponseti method

2. Pirani scoring
 Contents
• Pirani scoring
• Hindfoot contracture score
• Midfoot contracture score
• Recording Pirani scores
• Application of scoring
• Case Example
 Assessment of the Untreated Clubfoot & measuring
how it responds to treatment: The Columbian (Pirani)
Clubfoot Score: a simple way to measure a clubfoot
0
• Signs scored 0, 0.5, or 1
– Hindfoot Contracture Score (HFCS) 0-3
• Equinus
• Deep Posterior Crease
• Empty Heel 0.5
– Midfoot Contracture Score (MFCS) 0-3
• Curved Lateral Border
• Medial Crease
• Lateral Head of Talus
– Total Score (TS) 0-6 1.0
Hindfoot contracture: Posterior Crease
Score 0 Score 0.5 Score 1
Hindfoot contracture: Empty Heel
Score 0
Score 1
Hindfoot contracture: Rigid Equinus
Score 0 Score 0.5 Score 1
Signs for Midfoot Contracture Score:
Curved Lateral Border
Score 0 Score 0.5 Score 1
Midfoot Contracture: Medial Crease
Score 0 Score 0.5 Score 1
 Midfoot Contracture: Lateral Head of
Talus

Score 0 Score 0.5 Score 1

 Medical Record Number

Research Number

UNTREATED CLUBFOOT ASSESSMENT AND TREATMENT RECORD

i. Demographics Date of Initial Exa m:

Name: Sex: F M DOB:

Address: Town:

District: Clinic Name:

Mother’s Name:: Telephone :

Fathers Name: Tribe:

Orth Officer/Physio: Birth Attendant:

Place of Birth Hosp ( ) Clinic ( ) Home ( )

ii. History
Additional Notes/Details
Pregnancy:
Delivery:

Post Delivery:
Family History:

Treatment to Date:
Examination

Spine :

Hips:
Up extrem:

Low extrem:
Other:
 The Ponseti Method
HFCS = 3 MFCS = 2.5

Ponseti Casting

Tenotomy

HFCS = 2.5 MFCS = 0.5

The Ponseti Method: tenotomy & final cast
• The Columbian clubfoot score indicates when the
foot is ready for a tenotomy
– MFCS is one or less & HFCS more than one
– LHT = 0
– Heel in valgus
Clubfoot scores with Ponseti KK:Scores at start of
Treatment Ponseti Treatment
Curved Lat Border 1
Medial Crease 0.5
Lat Head Talus 1
MFCS 2.5
Post Crease 1.0
Empty Heel 1.0
Rigid Equinus 1.0
HFCS 3.0
TS 5.5
Clubfoot scores with KK:Scores after correction of
Ponseti Treatment abduction, before TA tenotomy
Curved Lat Border 0
Medial Crease 0
Lat Head Talus 0
MFCS 0
Post Crease 0.5
Empty Heel 1.0
Rigid Equinus 1.0
HFCS 2.5
TS 2.5
Clubfoot scores with KK: Scores after correction of
Ponseti Treatment abduction, and TA tenotomy
Curved Lat Border 0
Medial Crease 0
Lat Head Talus 0
MFCS 0
Post Crease 0.5
Empty Heel 0.5
Rigid Equinus 0
HFCS 1.0
TS 1.0
 KK: Clubfoot Scores with Ponseti Treatment

4
HFCS
Score

3 MFCS
TS
2

0
Week 1 Week 2 Week 3 Week 4 Wk 5- Wk 5+ten
tenotomy
Weeks of Treatment