A RELIABLE & VALID METHOD OF ASSESSING THE AMOUNT OF DEFORMITY IN THE CONGENITAL CLUBFOOT DEFORMITY

Abstract

This paper outlines a valid and reliable, clinical method of assessing the amount of deformity in the congenital clubfoot. Clinical & MRI clubfoot scoring systems were developed to score the amount of deformity clinically & to image & score osteochondral pathology of the club-foot -MRI Total Score (MTS), MRI Hindfoot Contracture Score (MHCS), & MRI Midfoot Contracture Score (MMCS), Clinical Total Score (CTS), Clinical Hindfoot Contracture Score (CHCS), Clinical Midfoot Contracture Score (CMCS). Three independent observers tested the Clinical scoring systems Inter-observer reliability (Kappa Statistic) over one hundred consecutive clubfeet. Kappa values were CTS-0.92, CMCS-0.91, and CHCS-0.86- (almost perfect inter-observer reliability). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. Validity was evaluated by correlating the MRI and clinical scores (Pearson Correlation). The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity.

There is neither reliability nor validity in current methods of clubfoot assessment. This paper outlines a method of assessing the amount of deformity in the congenital clubfoot deformity using six well-described simple clinical signs that has been tested & found to be both valid and reliable. A clinical clubfoot scoring system was created- Clinical Total Score (CTS)- comprised of a Clinical Hind-foot Contracture Score (CHCS) & a Clinical Midfoot Contracture Score (CMCS). One hundred consecutive congenital clubfeet were scored for clinical deformity each week during cast treatment by three independent observers. Inter-observer reliability (Kappa Statistic) of this clinical scoring system was evaluated. A clubfoot MRI protocol & scoring system were developed to visualise & score osteochondral pathology of the clubfoot -MRI Total Score (MTS)- comprised of a MRI Hindfoot Contracture Score (MHCS) and a MRI Midfoot Contracture Score (MMCS). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. All MRI films were scored for amount of osteochondral pathology. Validity of this clinical scoring system was evaluated by correlating the MRI and clinical scores (Pearson Correlation).

The Kappa values for inter-observer reliability were CTS-0.92, CMCS-0.91, and CHCS-0.86. All scores showed almost perfect inter-observer reliability. The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity of the clinical scores.

We have developed a clinical scoring system for club-feet that is reliable and valid.