Clubfoot Severity & Scoring (Classification)

There are two main clubfoot scoring and classification systems currently in use for initial and post correction classifications.

The Dimeglio scoring and classification system looks at 20 different points of criteria, while the Pirani scoring system assesses severity by looking at 6 different points of criteria. Most providers use the Pirani scoring system, although some use both and some only use Dimeglio.

Clubfoot scoring and severity really only has relevance as to how many Ponseti casts a child will need, and also has some bearing on the potential for relapse. More severe feet are only slightly more difficult to correct than less severe feet, and any qualified Ponseti Method provider will still only need to apply 5-7 weekly casts for most feet, even very stiff feet. Some feet will need a couple additional casts, with 9 casts total being the most any foot will require (yes, even the most severe and stiff feet).

Try not to put too much stock in your child's severity or the score that your doctor tells you. Most clubfeet will score high initially, and then when corrected should score 0 or as close to 0 as possible. Even the most severe and stiff feet can be corrected easily by a skilled Ponseti provider in 5-7 weekly casts.

Pirani Scoring System.

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Dr. Shafique Pirani developed a 6 point scoring system that is simple and easy for most clinical caregivers to use to asses the severity of the clubfoot. This scoring system applies both at birth and throughout the patient's life. A fully corrected clubfoot scores a 0, or as close to 0 as possible in this scoring system.

Dr. Pirani is nearing retirement, but sometimes still practices in Vancouver, British Columbia in Canada. His scoring system has been the system of choice for many years and is the most commonly used due to it's simplicity. Dr. Pirani frequently speaks globally as well!

BC parents can contact Dr. Pirani at the link below.

Dr. Shafique Pirani at Vancouver Coast Health Research Institute

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• Dimeglio has proposed a 20 point classification system. Both of the scoring systems have good inter-rater reliability but none predict long term outcome.

• Most of those who treat clubfoot feel that the Pirani scoring method is simpler to use and favor it over the Dimeglio scoring method.

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Dimeglio Scoring System.

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Dimeglio scoring is a 20 point system that takes into account 16 positions of range of degrees, and 4 visual criteria to total 20 points. It is more work for the clinician to work with than the Pirani system, and has no reported advantages over the Pirani System. However for full informative purposes, we show the basics of this 20 point system. If you want to further inquire about the Dimeglio scoring system, please contact a physician who can assess your child with it.

"The Dimeglio scoring system includes the visual estimation of the equinus, hind foot varus, midfoot rotation and forefoot adduction without forcing the foot, and each feature is given 0 to 4 points according to reducibility..."