Orthotic Management of Blounts Disease



- 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



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 1, 2011 1:55 pm