Blount disease


Blount disease

Description, Causes and Risk Factors:

Blount disease is defined as a growth disorder of the medial aspect of the proximal tibial physis, with abrupt medial angulation leading to varus angulation of the proximal tibia and medial rotation of the tibia.

There are three main types:

Blount disease
  1. Infantile tibia vara (Blount's disease) manifests in patients aged 1-3 years with typical radiographic findings.

  2. Late-onset juvenile.

  3. Late-onset adolescent.

The differentiation between physiological bowlegs and infantile Blount's disease (IBD) in patients aged 11-30 months is very difficult. The child with IBD presents with bowing and length discrepancy in the lower limbs and along the medial aspect of the proximal tibia a nontender bony protuberance can be palpated. The lower limb radiograph demonstrates the beaking of the proximal medial tibial metaphysis and a sharply angulated slope of the medial metaphysis of the proximal tibia.

Blount disease is a condition that results from abnormal growth in the upper part of the shin bone (tibia) and requires treatment for improvement to occur. Other causes for Blount disease in young children includes metabolic disease and rickets. Blount disease in teens typically occurs in youth who are overweight. In teens surgery is often required to correct the problem. This condition is more common among African-American children. It is also associated with obesity and early walking.

Several authors have suggested a mechanical basis for Blount disease given the observation of a predisposition for the disease in children who start walking at an early age and those who are overweight. The pathogenesis of the proximal tibial deformity is likely related to excessive compressive forces causing growth inhibition, as suggested by the Heuter-Volkmann principle. Excessive pressure at the medial portion of the proximal tibial cartilaginous epiphysis causes altered structure and function of the chondrocytes along with delayed ossi?cation of the epiphysis. Obesity can substantially increase the compressive forces generated on the medial compartment of the knee joint in a child with genu varum. Using ?nite element analysis, calculated the stresses at the proximal tibial growth plate during simulated single-limb stance and noted that, in a ?ve-year-old obese child.

Symptoms:

Blount disease is characterized by progressive bowing of the legs in infancy, early childhood, or adolescence. While it is not uncommon for young children to have bowed legs, typically the bowing improves with age.

One or both of the lower legs turn inward. This is called "bowing." It may:

    Look the same on both legs.

  • Occur just below the knee.

  • Rapidly get worse.

Diagnosis:

Early diagnosis and treatment of this disease is vital to avoidprogressive worsening. In infantile Blount disease, radiographof lower limb demonstrate bowing and abrupt medial angulation“beaking” of the medial cortical wall of the proximal tibialmetaphysis. On lateral knee radiographs showed posteriorlydirected projection at the proximal tibial metaphyseal level.The metaphyseal diaphyseal angle of 11º (this angle is formedby lines between metaphyseal beaks & perpendicular to thelongitudinal axis of the tibia) and tibial/femoral angle greaterthan 15º. Researchers reported that in patients with Blount'sdisease, the serum concentrations of inorganic phosphate andcalcium were lower and alkaline phosphatase activity wasincreased in the serum then controls group.

Treatment:

Treatment depends on the age of the patient and the severity of the condition. Treatment is customized for each patient on the basis of a variety of factors, including the child's age, the magnitude of the deformity, the limb-length discrepancy, psychosocial factors, and the surgeon's training and experience.

To achieve a successful outcome, treatment must be individualized on the basis of a comprehensive analysis of the limb deformities, the amount of growth remaining, the psychosocial status of the patient, and the ability of the surgeon to execute a well-outlined treatment plan with precision and safety.

Severe bowing before the age of three is braced with a hip-knee-ankle-foot orthosis or knee-ankle-foot orthosis. If the deformity does not correct before age 4-5 years, or if the patient presents with a moderate-to-severe deformity, corrective surgery such as a proximal tibial osteotomy is indicated. A tibial osteotomy is done before permanent damage occurs. Brace treatment for adolescent Blount's is not effective and requires surgery to correct the problem.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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