1. Perform a thorough examination using the Pirani scoring system to grade severity. 2. Initiate weekly serial casting, beginning with abduction of the foot and correction of cavus deformity. 3. Progress through sequential casts over 6-8 weeks to gradually correct all components of the deformity. 4. Most cases will require a percutaneous Achilles tenotomy to achieve full correction. 5. Maintain results with bracing in a abducted position for 23-24 hours per day for the first 3-4 years of

1. MOCK
Clinical Examination
CFD Sort case
Prof. Anisuddin Bhatti
Dr. Ziuaddin University Hospital
Clifton, Karachi.
dranisbhatti@gmail.com

2. 4 short case: System
10 Minutes on each case
1 minutes un-observed delay in between to switch over candidates
• 5 minutes for clinical examination
• 5 Minutes for Viva
• One examiner ask Q & other to observe OR other examiner may ask Q to clarify statement
given by Examinee
Examiner gives command for what to examine and give brief history
Examinee can ask 1-2 relevant questions about patient condition, investigation or
response to therapy.
Examiner may respond verbally or furnishes results if asked for.
Examinee may narrate findings
• Answers are scored phase-wise on a key.

3. 7 yrs age Girl
Foot Deformity: Bilateral
• She Had Previous
serial casting at 3
months age
• Left Incomplete
treatment without
bracing protocol
• Presented with this
status of both feet.
• Kindly proceed
to examine her
left leg.

4. 7 yrs age Girl, Foot Deformity: Bilateral
Detailed but focused examination. Narrate ur findings ?
LOOK, FEEL & MOVE

5. Detailed
MSK
Examinatio
n
2 marks
LOOK,
FEEL &
MOVE
Most Important To Concentrate :
Feet & Legs
CAVE
Abductus
Dorsiflexion
Neurology
Muscle weakness
o Toe extensors
o Peronie
o Tibialis anterior
Required
• Screening Exm: Quik Survey
• General : Other than MSK
Knee ?
 Architecture, Deformity,
Dimple
 ROM
Hips?
 Abduction
 Galleazi test
Spine?
 Dimple
 Bifida Occulta
Exclude AGMC: associated
deformities
To establish Type of CFD:
• Ideopathic
• Meuropathic
• Syndromic
• Post Surgical

6. Phase1 Viva Voice
total 4 Marks: Attiers 1 marks
•Examinee may collect some
more information on history
and perform focused
examination, as asked for.
At the beginning of Viva examiner
may ask for, additional points you
would like to gather on history &
examination?
Additional Questions
1.Family history
2. Drug history
3. Oligohydromnios

7. Phase-2. total 6 marks
Presentation Technique & Correctness of findings 1 marks
• Cavo Varus
• Lateral lengthening
• Cuboid Callosity
• Equineous
• Heel Varus
• Heel Rotation
• Supination
• Hyperactive Tibialis anterior
• Rigidity in correction
Must Establish :
• Dynamic Supination?
• Exclude Peroneal Dystrophyy

8. Phase-2. Examiners Questions
2 marks
After Candidate has furnished his findings on history and
examination, Examiner may ask:
1. What is the likely diagnosis and why?
2. How to grade severity of the deformity?
3. What investigations you would like to order and why?

9. Q: Classification: 1 Mark
• Harold & Walker
• Ponseti
• Dimelio
• Pirani
• Which is more practicable
• What are Major
components of Pirani score
• What additional points are
required to make Pirani
More Comprehensive
• Harold & Walker: Basic & simple
• Ponseti: based of softness & rigidty
• Dimelio: More comprehensive each
component subclassified
• Pirani: Mid foot & hind foot
subclassified
• Which is more practicable
• What are Major components of Pirani
score: Mid Foot & Hind foot score
• What additional points are required to
make Pirani More Comprehensive:
Abductus & Dorsfifexion

11. Pirani scoring and its Prediction Value
Significant Predective Value & Preogressive Evaluation
Addition:
Abductus: Minus to Plus
Dorsiflexion Minus to Plus

12. Phase-2: Radiological Findings
1 marks
Candidate must ask investigations:
X-Ray, LAB report
1. What do you find on X-Ray?
2. How will you proceed further?
If the candidate reads X-Ray correctly, draw
referral lines and request additional
imaging show him and examiner may ask
why & what?
CT / MRI
• Usually not required &
asked for in younger age
• Here in this age U can do

13. Phase 2.
Management
plan
2 marks.
Each section
carries 1mark
Q. Non-operatieve
or
Q. Operative
Justify
1. What specific
Non operative
Rx & How.
2. What specific
Procedure
needs to be
done
• Any other
additional
procedure &
why
TATT
Cuboid Decancelation
Dylwin Evan
Post-Operative Management & Bracing

14. Second Clubfoot
Case

15. Look at photograph of
a 1 week old baby
• She is born with bilateral foot
deformity
• Born NVD
• No history of prenatal problems
• You can ask two relative
questions.

16. Proceed to focus
clinical examination
1. What is your provisional diagnosis ?
2. How would you proceed to examine this
patient ?
3. What additional examination you would
like to do & why ?
4. What are the charachteristic features to
confirm your dagnosis?

17. Grading the severity
of deformity
1. How would you grade the severity of
deformity ?
2. Which scoring system is commonly
used?
3. What essential features you check in
that scoring system?

18. Management plan
1. How would you manage this deformity in this 1 week old baby ?
2. What is the first step to correct which deformity ?
3. What next steps you do to correct deformity?
4. What last to need correction & how ?
4. How would you maintain the correction & how long ?