OBJECTIVE: The aim of this study was to verify whether the Pirani and Dimeglio clinical scoring systems could predict results of Ponseti therapy. METHODS: Forty-seven patients with clubfoot deformities treated with the Ponseti method were enrolled in the study. Clinical evaluation with the Pirani and Dimeglio scoring systems was performed before the treatment and after the second cast fixation. The number of fixations, necessity for achillotomy, and recurrence of the deformity were determined as parameters of the therapy results. The patients were divided into three groups according to the severity of their deformities, and the groups were compared with one another. RESULTS: Clubfoot correction required an average of 6.8 casts. Five patients developed a recurrence. Comparing the therapy outcomes among the groups, we found statistically significant differences in the Pirani classification after the second fixation (the number of casts [p =.003] and necessity to perform an achillotomy [p =.014]) and in the Dimeglio scores before therapy (number of casts [p =.034]) and after the second fixation (number of relapses [p =.032]). CONCLUSION: Although clinical scoring systems showed some dependence on the parameters of treatment outcomes, their predictive function can be used in only a limited way. Level of evidence II, Prospective comparative study.

OBJETIVO: O objetivo deste estudo foi verificar se os sistemas de pontuação clínica de Pirani e Dimeglio poderiam servir para prever os resultados do tratamento com o método de Ponseti. MÉTODOS: Quarenta e sete pacientes com diagnóstico de pé torto equinovaro tratados pelo método de Ponseti foram incluídos no estudo. A avaliação clínica com os sistemas de pontuação de Pirani e Dimeglio foi realizada antes do tratamento e depois da segunda fixação de gesso. O número de fixações com gesso, a necessidade de realização de aquilotomia e a recorrência da deformidade foram determinadas como parâmetros dos resultados do tratamento. Os pacientes foram divididos em três grupos, de acordo com a gravidade das deformidades, e esses grupos foram comparados entre si. RESULTADOS: A correção do pé torto exigiu uma média de 6,8 gessos e cinco pacientes apresentaram recidiva. Ao comparar os resultados do tratamento entre os grupos, verificou-se diferença estatisticamente significante na classificação de Pirani após a segunda fixação (número de gessos [p = 0,003], necessidade de realizar aquilotomia [p = 0,014]) e pontuação de Dimeglio antes do tratamento (número de gessos [p = 0,034]) e depois da segunda fixação (número de recidivas [p = 0,032]). CONCLUSÃO: Embora os sistemas de pontuação clínica tenham mostrado alguma dependência dos parâmetros dos resultados do tratamento, sua função preditiva pode ser usada de maneira limitada. Nível de evidência II, Estudo comparativo prospectivo.

Masaryk University Medical Faculty Faculty Hospital Children´s Medical Centre Brno Czech Republic

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