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      The PBS Score – a clinical assessment tool for the ambulatory and recurrent clubfoot

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          Abstract

          Purpose

          The signs for clubfoot relapse are poorly defined in the literature and there is a lack of a scoring system that allows assessment of clubfeet in ambulatory children. The aim of this study is to develop an easy to use, reliable and validated evaluation tool for ambulatory children with a history of clubfoot.

          Methods

          A total of 52 feet (26 children, 41 clubfeet, 11 unaffected feet) were assessed. Three surgeons used the seven-item PBS Score to rate hindfoot varus, standing and walking supination, early heel rise, active/passive ankle dorsiflexion and subtalar abduction blinded to the other examiners. All parents answered the modified Roye score questionnaire prior to the clinical assessment. Correlation between the mean PBS Score and the Roye score was evaluated using Spearman’s rank correlation coefficient. Interobserver reliability was tested using weighted and unweighted Cohen’s Kappa coefficients.

          Results

          The Spearman’s rank correlation coefficient for correlation between mean PBS Score and Roye score was 0.73 (moderate to good correlation).The interobserver agreement for the total PBS Score resulted in an intraclass correlation coefficient of 0.93 (almost perfect agreement).

          Conclusion

          The PBS score is an easy to use, clinical assessment tool for walking age children with clubfoot deformity. It includes passive and active criteria with a very good interobserver reliability and moderate to good validity.

          Level of Evidence:

          Level I - Diagnostic study

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          Most cited references23

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          Treatment of idiopathic clubfoot. A thirty-year follow-up note.

          We evaluated forty-five patients who had seventy-one congenital clubfeet. The average age was thirty-four years (range, twenty-five to forty-two years). Twenty-nine of these patients had been evaluated and reported on in 1980. We performed pedobarographic and electrogoniometric analyses in addition to the clinical and radiographic studies performed previously. With the use of pain and functional limitation as the outcome criteria, thirty-five (78 per cent) of the forty-five patients had an excellent or good outcome compared with eighty-two (85 per cent) of ninety-seven individuals who did not have congenital deformity of the foot. The patient's occupation, passive dorsiflexion as measured with a hand-held goniometer, the antero-posterior calcaneus-fifth metatarsal angle, the total foot pressure time integral, and the number of rapid single-limb toe-ups that could be performed were the only variables that differed significantly between the feet that had an excellent or good result and those that had a poor result (p < 0.05). A comparison of the feet that had an excellent or good outcome with those that had a poor outcome with regard to body-mass index, peak pressure under the heel, and force time integral under the metatarsal heads revealed a p value that was between 0.05 and 0.08 for each variable. The technique of treatment led to good long-term results in our patients who had clubfoot. The data suggest that a sedentary occupation and avoidance of excessive weight gain may improve the over-all long-term result. Excessive weakening of the triceps surae may predispose patients to a poor result; therefore, it is prudent to avoid overlengthening of this muscle. The outcome could not be predicted from the radiographic result.
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            Long-term results of treatment of congenital club foot.

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              An independent assessment of two clubfoot-classification systems.

              We conducted an independent assessment of two clubfoot-classification systems. In a blinded trial, two orthopaedists scored 55 feet by using the classification systems developed by Pirani et al. and by Dimeglio et al. Thirty-seven of the feet were also scored by a physical therapist. By using the 10-point classification described by Pirani, the two physician examiners tallied total scores that were within one point of one another 89% of the time. The mean difference between the scores assigned by the two examiners was 0.6 points. For the 20-point classification described by Dimeglio et al., total scores tallied by the two physician examiners were within two points of one another 91% of the time. The mean difference between the scores assigned by the two physician examiners was 1.4 points. Correlation coefficients were 0.90 (p = 0.0001) for the Pirani classification, and 0.83 (p = 0.0001) for the Dimeglio classification. Correlation coefficients were much lower for the first 15 feet scored and were also lower when the therapist's scores were included. Overall, both classification systems had very good interobserver reliability after the initial learning phase.
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                Author and article information

                Journal
                J Child Orthop
                J Child Orthop
                jco
                Journal of Children's Orthopaedics
                The British Editorial Society of Bone & Joint Surgery (London )
                1863-2521
                1863-2548
                1 June 2019
                : 13
                : 3
                : 282-292
                Affiliations
                [1 ]org-divisionDepartment of Women’s and Children’s Health, Karolinska Institutet , Stockholm, Sweden
                [2 ]org-divisionKing’s College Hospital London in Dubai , Dubai, United Arab Emirates
                Author notes
                [*]

                Both authors have contributed equally to this work.

                Correspondence should be sent to Stephanie Böhm, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden. E-mail: stephanie.bohm@ 123456ki.se
                Marc Sinclair, King’s College Hospital London in Dubai, UAE – Orthopaedics Dubai, United Arab Emirates. Email: dr.marcsinclair@ 123456gmail.com
                Article
                jco-13-282
                10.1302/1863-2548.13.190077
                6598041
                31312268
                889ab716-9a58-4a7c-a0b9-1f611e8d611e
                Copyright © 2019, The author(s)

                Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                History
                : 6 May 2019
                : 21 May 2019
                Categories
                Original Clinical Article
                childrens-orthopaedics, Children’s Orthopaedics

                Orthopedics
                clubfoot,scoring system,recurrence
                Orthopedics
                clubfoot, scoring system, recurrence

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