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Blount's Disease
Synonyms: Tibia vara
Blount's disease is a disorder of the tibial growth plate (usually medial aspect) leading to changes in the angle at the knee. This results in bowing of the leg (usually lower leg). However, unlike bowlegs it is pathological and progressively worsens. Clinically it is difficult to distinguish between simple bowlegs and Blount's disease. However, bowlegs should resolve between the ages of 2-4 years - if not then one should suspect Blount's disease.1
Epidemiology
Presents at age 2-4 years
Risk factors
Repetitive trauma to a knee with an already varus abnormality
Presentation
Investigations
Plain radiographs show increased angulation between the metaphysis and the longitudinal axis of the tibia.
- Physiologic bow legs
- Rickets
- Osteomyelitis
- Trauma
- Ollier's disease
- Metaphyseal chondrodysplasia
- Focal fibrocartilaginous dysplasia
Management
- Braces - these are long-legged and lock the knee and need to be worn whilst weight bearing.
- However, if by the age of 4-5 years the condition has not corrected then surgery is usually required.
- Surgery usually involves osteotomy of the tibia and realignment of the lower leg.
Prognosis
- Bracing is usually unsuccessful in girls and those with obesity.
- If treatment is successful there is usually no residual disability or cosmetic abnormality.4
Usually the adolescent variety is less severe than infantile Blount's disease.
Risk factors
- Bowlegs
- Females
- Afro-caribbean ethnicity
- Obesity
- Walking at early age
- Possible family preponderance
Presentation
- Commonly unilateral
- Varus deformity
- Shortening of involved leg up to 3-4 cm
- Pain at the medial prominence of the proximal tibia
- Medial tibial torsion may also be present
Investigations
Plain radiographs as for infantile Blount's.
Treatment
High tibial osteotomy is usually the procedure of choice. This is attractive as limbs are not shortened however it requires the wearing of an external fixator for several months.
Document references
- Blount's disease; e-Radiography.
- Infantile Blounts disease; Paediatric Genu Varum; Wheeless' Textbook of Orthopaedics
- S.R. Boyea and J.R.Bowen; Clinical case presentation on Blount's disease; June 1996.
- Blount's disease; Medical Encylopedia; Apr 2006.
- Adolescent Blounts Disease, Wheeless' Textbook of Orthopaedics
Internet and further reading Acknowledgements EMIS is grateful to Dr Gurvinder Rull for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 8601
Document Version: 1
DocRef: bgp26114
Last Updated: 13 Dec 2007
Review Date: 12 Dec 2009
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