Association between video-based Pirani Böhm Sinclair score and treatment recommendations in recurrent clubfoot in walking-age children

BACKGROUND: Management of recurrent clubfoot in walking-age children remains inconsistent, with substantial variation in treatment strategies. The role of clinical scoring systems in guiding treatment decisions in this group is unclear. This study investigated whether the video-based Pirani Böhm Sinclair (PBS)-score is associated with treatment recommendations. METHODS: Fifty-five children aged 4-15 years (85 clubfeet) were video-documented. Four international paediatric orthopaedic surgeons independently assessed each case using the PBS-score and recommended management. RESULTS: Higher total PBS-scores were significantly associated with lower odds of recommending observation (OR 0.2, p < 0.002). A threshold around PBS-score 10 marked a consistent shift from observation to active intervention. Median PBS-scores were 8 (7-10) for observation and 13 (11-16) for active treatment. Despite this association, there was substantial variability in the type of intervention recommended. Even when specific clinical findings, such as dynamic supination, were consistently identified, this did not uniformly translate into the same surgical decision. CONCLUSION: While higher PBS-scores are associated with the decision to intervene, considerable variation in treatment choice persists. These findings highlight the lack of consensus in managing recurrent clubfoot and underscore the need for clearer indications and standardized treatment algorithms. Trial registration Clinical trial number NCT06050564, date of registration 2023-09-11.