In congenital talipes equinovarus (CTEV), the Pirani scoring system assesses hindfoot and midfoot contracture. The component that, if score = 1 (maximum), indicates the MOST severe hindfoot involvement is:

• A Curved lateral border of the foot
• B Medial crease
• C Lateral head of talus uncovered
• D Empty heel (absent posterior calcaneal fat pad) ✓

Explanation

The Pirani hindfoot score assesses: posterior crease severity, empty heel, and equinus rigidity. An 'empty heel' (impalpable posterior calcaneal fat pad) scores 1 and indicates that the calcaneum is severely elevated and equinus is rigid — the most prognostically significant sign for requiring Achilles tenotomy. Ponseti method requires percutaneous Achilles tenotomy in ~90% of cases when the hindfoot cannot achieve dorsiflexion beyond neutral after 4–5 plaster changes; empty heel predicts this requirement.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.