Pirani Score Example

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Scoring the foot at each visit during treatment enables the physiotherapist or health care worker treating the child to document how the foot is responding to the manipulation and casting. It also assists in determining when to perform the Achilles Tenotomy.

Role of Pirani.png

Pirani Score Assessment

Consider the following examples which highlight different elements of the Pirani Score Process.

Example 1 Scoring the Foot

Medial Crease

What is the Medial Crease Score? [1]

Medial Crease.png

Lateral Border

What is the Lateral Border Score? [1]

Lateral Border.png

Posterior Crease

What is the Posterior Crease Score? [1]

Posterior Crease.png

Rigid Equinus Score

If this is the maximum dorsiflexion, what is the Rigid Equinus Score? [1]

Rigid Equinus Score.png

Example 2 Calculating the Pirani Score

After assessment with the Pirani Score, you find: [1]

  • Medial Crease (MC) = 0
  • Curved Lateral Border (CLB) = 0.5
  • Lateral Head of Talus (LHT) = 0
  • Posterior Crease (PC) = 1
  • Empty Heel = 0.5
  • Rigid Equinus = 0.5

What is the Total Midfoot Score?

What is the Total Hindfoot Score?

What is the Total Pirani Score?

Is this patient ready to undergo Tenotomy?

Example 3 Determining Readiness for Tenotomy

Based on the following Pirani Scores, which of these patients is ready for Tenotomy? [1]

Patient 1: CLB 0, LHT 0.5, MC 0, PC 0.5, RE 1.0, EH 1.0 Total Score = 3

Patient 2: CLB 0, LHT 0, MC 0, PC 1.0, RE 1.0, EH 1.0 Total Score = 3

Patient 3: CLB 0, LHT 0, MC 0.5, PC 1.0, RE 1.0, EH 0.5 Total Score = 3


  1. 1.0 1.1 1.2 1.3 1.4 1.5 Africa Clubfoot Training Project. Chapter 4 How To Assess the Severity of a Clubfoot using the Pirani Score. Africa Clubfoot Training Basic & Advanced Clubfoot Treatment Provider Courses - Participant Manual. University of Oxford: Africa Clubfoot Training Project, 2017.