SLR - February 2020 - Scott G. Bird
Reference: Brazell C, Carry PM, Jones A, Baschal R, Miller N, Holmes KS, Georgopoulos G. Dimeglio Score Predicts Treatment Difficulty During Ponseti Casting for Isolated Clubfoot. J Pediatr Orthop. 2019 May/Jun;39(5):e402-e405.Scientific Literature Review
Reviewed By: Scott G. Bird, DPM
Residency Program: Scripps Mercy Kaiser Hospital – San Diego, CA
Podiatric Relevance: Isolated clubfoot is often successfully treated by podiatric physicians using the Ponseti method of clubfoot casting with or without Achilles tenotomy. However, there is variability among patients with isolated clubfoot with regards to the duration of treatment and the possibility of recurrence. Previous reports have had varying results on the reliability of using the Dimeglio score to predict recurrence and casting duration. This study aims to establish a predictive element of length of casting and risk of recurrence for new clubfoot families from the Dimeglio score.
Methods: A retrospective chart review of patients treated for isolated clubfoot at a single center over a three-year period (2012-2015) with two-year follow-up was performed. Syndromic and neuromuscular clubfoot were excluded from the study. Initial Dimeglio score at first clinic visit was calculated. Statistical analysis was used to examine the total Dimeglio score and each of its eight parameters as they correlate to the number of casts used to achieve successful correction of isolated clubfoot as well as deformity recurrence.
Results: Fifty-three patients were included in the study. The median number of casts used to achieve a successful correction of isolated clubfoot before tenotomy was five (range two to 16) and the incidence of recurrence was 24.53 percent overall. A higher total Dimeglio score at initial visit was associated with a significant increase in the number of casts required to achieve correction. In addition, certain parameters of the Dimeglio score were also found to be significantly associated with an increase in the number of casts. These included more severe derotation, varus, equinus and muscle condition parameter scores. An increased total Dimeglio score at initial visit was also found to be significantly associated with incidence of recurrence.
Conclusions: The authors conclude that the Dimeglio scoring system is an objective means to gauge the severity of isolated clubfoot deformity with significant prognostic utility. It can predict the need for an increased number of casts and help clinicians and families plan for the possibility of future procedures and/or deformity recurrence. Specifically, patients that present with a more severe degree of derotation, varus, equinus or muscle condition scores can be predicted to require more casts. This is helpful for parents who often want to know how many casts their child will require. The Dimeglio score can be successfully used in predicting outcomes in treatment of isolated clubfoot and podiatric practitioners should consider using it when they encounter these patients.