In congenital talipes equinovarus (CTEV), the Pirani scoring system assesses which of the following parameters?

• A Five clinical parameters scored 0–2, with a maximum score of 10
• B Radiological Talar-first metatarsal angle, Calcaneal-first metatarsal angle, and tibio-calcaneal angle
• C Three hindfoot signs and three midfoot signs, each scored 0 (normal), 0.5 (moderate abnormality), or 1 (severe abnormality), maximum 6 ✓
• D Dimeglio classification score based on reducibility, equinus, and rotation

Explanation

The Pirani scoring system is the most widely used clinical tool to assess CTEV severity and response to Ponseti casting. It evaluates six signs: three hindfoot (posterior crease, emptiness of heel, rigid equinus) and three midfoot (medial crease, lateral head of talus covered, curvature of lateral border of foot). Each sign is scored 0 (normal), 0.5 (moderately abnormal), or 1 (severely abnormal), giving a maximum total of 6. A higher score predicts more casts needed and higher tenotomy rate. Dimeglio is a separate classification system. Radiological angles are used in assessment but not in Pirani scoring.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.