An independent assessment of two clubfoot-classification systems

We conducted an independent assessment of two clubfoot-classification syste ms. In a blinded trial, two orthopaedists scored 55 feet by using the class ification systems developed by Pirani et aI. 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 tall ied 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., to tal scores tallied by the two physician examiners were within two points of one another 91% of the time. The mean difference between the scores assign ed 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 score s were included. Overall, both classification systems had very good interob server reliability after the initial learning phase.