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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