A newborn has a right foot with equinus, varus of the heel, adduction of the forefoot, and cavus deformity. This is CTEV. The Pirani scoring system allocates up to 3 points for hindfoot and 3 points for midfoot components. A Pirani score of 5 implies:

• A Mild CTEV requiring only passive stretching
• B Failed conservative treatment requiring primary posteromedial release
• C Neuromuscular CTEV not amenable to Ponseti method
• D Severe CTEV — likely to need tenotomy of the Achilles tendon after Ponseti casting series ✓

Explanation

The Pirani score ranges from 0 (normal) to 6 (maximal severity) across six signs: posterior crease, empty heel, equinus (hindfoot) and medial crease, talar head coverage, curved lateral border of foot (midfoot). A score of 5 is severe CTEV; despite severity, the Ponseti method (weekly serial casting in a specific sequence) is effective even in high-score feet. After 5–8 casts, most severe feet require percutaneous Achilles tenotomy to correct residual equinus, followed by foot abduction brace. Posteromedial surgical release is now avoided as a primary treatment due to stiffness and recurrence.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.