Pirani score during manipulation and casting; points to remember
During every visit (Casting, Tenotomy, Bracing and follow up) it is mandatory to carefully evaluate the foot and record the Pirani score
After the first cast (supinated position) the Pirani score may not change and that is acceptable.
However, if there are no changes in the Pirani score during the weekly casting stage for three weeks, i.e. three casts, a senior practitioner should look at the manipulation and cast. No change in Pirani score may indicate bad technique or a complicated foot that requires a second opinion. Or there would have been a cast slip that was not noticed. (However, among children over two years, there are chances that for the first three to four weeks, the score remains the same and only at the time of the fourth or fifth cast, the Pirani score start showing different points.
If one foot scores a zero and is ready for tenotomy but the other requires additional casting for tenotomy, both feet should be cast. The tenotomy should be performed at the same time so that the feet are prepared uniformly for applying the foot abduction brace.
The midfoot score may not come to zero immediately because it takes time for the medial crease to disappear. That is why it is said that the time for tenotomy is when the midfoot score is equal or less than 0.5.
Rigidity of equines is always corrected by tenotomy and not by forceful manipulation and casting. (forceful correction leads to rocker bottom foot)
Varus is automatically corrected to valgus position when the foot is supinated and abducted because of the kinematic coupling structure of the foot.
So, it is important to note that the foot is never pronated and while manipulating or casting the calcaneus is never touched or manipulated.
If the Pirani score is not used, the treatment cannot be considered as the authentic Ponseti method. It is important to score and document the progress of treatment and make informed decisions to move to further phases and stages of treatment based on the Pirani score.
It should take less than a minute to measure and record the Pirani score. If any doctor or healthcare professional is giving an excuse that time constraints don’t allow them to score, please facilitate refresher training so that the Pirani score can be learned understood and used effectively. The Pirani score is simple and very effective in bringing the Ponseti method to a successful conclusion.
Understanding and use of the Pirani score refers to the confidence level of the healthcare professional in using the Ponseti method successfully.
There are two things you see, two things you feel and two things that you measure to record Pirani's score.
