Orthotic Management of Blounts Disease - Wheeless' Textbook of Orthopaedics

- Discussion:
- principle of orthotic management in infantile tibia vara is alteration of abnormal compressive
forces so that normal growth will resume & genu varum will be corrected;
- patient age:
- historically, bracing has been the treatment of choice for a child 14 - 30 months old with infantile tibia vara;
- the problem w/ this is that often the diagnosis cannot be reliably made until age 2 to 2.5 yrs;
- because it takes about one year for the physician to know whether brace treatment has been successful,
treatment of 30 - 36-month-old child should include consideration of other factors;
- obesity, female gender, and a poor social situation are poor prognostic signs for successful bracing;
- physeal slope:
- prescribe orthosis if medial physeal slope is less than 50 degrees;
- consider tibial osteotomy when medial physeal slope is > 60 deg;
- w/ medial physeal slope of 50 - 60 deg, orthotic treatment is considered if there are risk factors;
- obesity, female gender, and a poor social situation are poor prognostic signs for successful bracing;

- Elements of the Brace:
- orthosis includes knee brace w/ free ankle, single medial upright, & no hinge joint at the knee;
- cuff around knee pulls leg into valgus angulation;
- hinge joint at knee is not needed for sitting activities in these young children;
- elimination of the knee joint from the brace makes it easier to align cuff, makes the brace
more adaptable for subsequent growth, and allows easy adjustment of the medial upright;
- every 6-12 weeks, medial upright can be bent to gain further valgus alignment at knee;