In congenital talipes equinovarus (CTEV, clubfoot), the Pirani score is used to guide treatment. In the Ponseti method, casting is continued until the Pirani score reaches what value before tenotomy is considered?

• A Total Pirani score ≤1 with hind-foot score ≤0.5
• B Total Pirani score of 0 (complete correction without tenotomy required)
• C Total Pirani score ≤2, after which percutaneous Achilles tenotomy is performed if equinus persists ✓
• D Total Pirani score ≤3, after which surgery is performed if hind-foot is not corrected

Explanation

In the Ponseti method, serial casting corrects all components of clubfoot (cavus, adductus, varus) sequentially; the final deformity to correct is equinus. When the total Pirani score reaches ≤2 (or when all components except equinus are corrected) and significant equinus persists (dorsiflexion <10°), percutaneous Achilles tenotomy is performed under local anaesthesia. A final cast is then applied for 3 weeks to allow Achilles tendon healing with the foot in maximum dorsiflexion. Post-cast foot abduction orthosis (Denis Browne splint) is worn for 3–4 years to prevent relapse.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.