Monitoring the Club Foot

The Pirani Score

The Pirani score is used to assess the severity of a club foot in a baby. It is a simple assessment that involves the examiner observing and gently manipulating the baby’s foot.

The examiner will score 6 features of the baby’s foot.

Three features describe the severity of the mid foot position (contracture) and three describe the severity of the hind foot position (contracture). Each feature is scored 0, 0.5 or 1. With a score of 1 being the most severe for each feature.

A total score of 6 indicates a severe presentation of club foot. A lower score indicates a less severe presentation.

Mid Foot Contracture Score

  • Medial Crease – describes the presence and depth of creases on the inside of the foot
  • Curved Lateral Border – describes the shape of the outside of the baby’s foot
  • Lateral head of Talus – describes the position of the baby’s mid foot in relation to the talus bone

Hind Foot Contracture Score

  • Posterior Crease – describes the presence and depth of the crease at the baby’s heel
  • Empty Heel – describes the position of the heel bone
  • Rigid Equinus – describes how flexible the foot is and is score by how far the examiner can gently move the ankle

As well as describing the severity of a club foot of a baby at initial assessment, the Pirani score can be used to monitor progress of Ponsetti cast treatment between each cast.