Predicting short term outcomes of infants receiving Ponseti management for idiopathic clubfoot

This thesis explores a different way of using the most common clubfoot scoring system, the Pirani scale, to provide prognostic information. Currently, predicting treatment outcomes using total Pirani scale scores at initial assessment has varied results. Anecdotally, different patterns of midfoot and hindfoot correction in idiopathic clubfoot during Ponseti management have been noted in the clubfoot clinic at a paediatric tertiary institution. However, the prognostic value of change in Pirani scale midfoot (MFS) and hindfoot (HFS) components during Ponseti management has not been robustly investigated. Therefore, a retrospective study reviewing medical records of 226 children with 335 idiopathic clubfoot from 2008-2020 was completed. Group-based trajectory of MFS and HFS identified four subgroups of clubfoot that followed statistically distinct patterns of change during Ponseti management. Tenotomy rate differed between the subgroups demonstrating the role of subgrouping to predict outcomes in Ponseti managed idiopathic clubfoot. This is the first report of the existence of four subgroups of idiopathic clubfoot and their ability to predict some short term treatment outcomes. Future research should focus on prospectively evaluating the existence of these subgroups in other idiopathic clubfoot cohorts and the ability of the subgroups to predict long term treatment outcomes.