Blount’s disease is a progressive disorder that harshly affects bones of the lower leg, resulting in an inward curvature. It is generally categorized as infantile Blount’s disease, which affects young kids mostly before the age of 4 years & adolescents affecting older kids & teenagers. Up to 75 percent of cases are bilateral (meaning both the legs are impaired) in young children, while teenagers are more likely to have this condition in a single leg. Blount’s disease is contrastive from bow-leggedness, which is more commonly seen in toddlers. Babies’ legs are impulsively bowlegged due to normal posture of fetus in the mother’s womb prior to birth. This curvature spontaneously straightens out when babies begin to walk. But, in a kid with Blount’s disease, this curve will not rectify itself over time & will worsen if it is left untreated.
What is Blount’s Disease?
Blount’s disease can be defined as a growth disorder of tibia (shin bone) in which the lower leg of infant turns in an inward direction, making it look like bowleg. This can cause problem with normal walking activity in kids & which is why prompt diagnosis is extremely important. Currently, it is considered as a rare condition & is known to affect 1 child per 2,000.
Blount’s disease may appear in young children as well as adolescents. Its cause is still unknown. It is considered to be due to unfavorable effects of weight on the growth plate. The inner portion of the tibia, just below the knee, falls short as it fails to grow normally. Unlike condition of bowlegs, which have a tendency to straighten as kids develop, Blount disease moderately gets worse. It can cause serious bowing of either single or both legs. This disorder is also associated with excessive weight & early walking. Weight should, therefore, be maintained properly in order to prevent worsening of this condition.
Severe bowing of legs in which one or both of lower legs bend inward usually feature the following signs & symptoms.
- Appears just below the knee
- Seem the same on both legs
- Quickly gets worse
In some cases, child’s one leg may also become slightly shorter than the other.
There are two main types of Blount’s disease. First one is infantile Blount’s disease, which appears between the ages of 1 month to 3 years & is more generally observed than the second type. The other is adolescent Blount’s disease, which appears in kids over 9 years of age. Bowed legs are almost normal finding in babies under 2 years & which usually improve by 18 to 24 months of age. Infantile Blount’s disease more commonly appears around the same age, but the bowing condition does not get better & instead worsens over time.
- Infantile Blount’s Disease
- Commonly affects both legs (bilateral)
- Abnormality seen in tibia (shin bone) only
- Adolescent Blount’s Disease
- More probably affects one side only (unilateral)
- Deformity mostly occurs in both the femur (thigh bone) as well as tibia
Pediatric orthopedists can identify Blount’s disease with help of complete health assessment & some important imaging tests. Diagnosis of Blount’s disease is dependent on physical evaluation & a standing alignment x-ray test, in which a complete picture of the leg, from hip to ankle is taken. Pediatric orthopedists use this precise image to find out the mechanical axis of malformation as well as its position.
Generally, primary treatment for infantile Blount’s disease is bracing, normally applied for a period of up to one year to observe its effectiveness. Standard bracing protocol includes using a brace during infant’s waking hours with the knee in complete augmentation during weight bearing. When progressive corrections fail to occur, surgery may be suggested. However, outcomes of surgery are much better before the child reaches the age of four years than after, when the recurrence ratio of bowing increases gradually.
Children may have difficulty walking without tripping. Walking pattern of the child may not appear normal. Parents should make a note of all these things & meet a pediatric orthopedist. Parents should discuss symptoms the child is suffering from & ask for guidance. Pediatric orthopedists will most likely take a physical test of the child & recommend appropriate treatment option.
Parents should not get worried as Blount’s disease can be successfully treated with appropriate measures. Pediatric orthopedists can help parents to understand treatment procedures for Blount’s disease which are available for the child. Mentioned below is a list of some important questions which parents should ask surgeons during the initial consultation appointment.
- What is Blount’s disease?
- Who can get Blount’s disease?
- What are the risk factors & causes of Blount’s disease?
- What are common indications of this disorder in children?
- What is the result of my child’s diagnostic tests?
- What treatment option do you suggest for my kid?
- What are the possible complications of the recommended treatment for this disorder?
- What is the prognosis of surgery for Blount’s disease?
- What is the approximate recovery time following this procedure?
- Will my child be able to walk normally post-surgery?
Parents should frankly voice their concerns regarding treatment of Blount’s disease in order to avail positive outcomes.
Surgical correction procedure of Blount’s disease involves the following steps.
- Osteotomy – During surgical correction, pediatric orthopedists execute osteotomy which involves cutting the fibula & tibia as near to the growth plate as possible & re-adjusting bones.
- Fixator – Following the procedure, pediatric-orthopedic surgeons position a fixator on the child’s leg to uphold appropriate alignment during the healing phase. In severe (acute) correction, a single-lane or mono-lateral fixator is used by surgeons. In case the correction is steady, a circular fixator (sometimes known as Ilizarov apparatus) is used. This type of fixator can also be used by surgeons when extra procedures are involved simultaneously for rectifying other deformities such as limb length inconsistency. Fixator is recommended to be worn for between 6 to 12 weeks while the leg heals.
Primary approach for patients suffering from adolescent Blount’s disease is generally guided growth. This treatment engages the pediatric orthopedic surgeon to plant a small plate & few screws against the lateral portion of tibia, where growth of bone has eventuated. This restricts development on the growth side while permitting growth on the medial side. As the child grows normally, malformation is progressively rectified. If guided growth does not show any improvement in treating deformity or if the patient does not have scope for growth, the desired modification may not be possible & osteotomy may be suggested by surgeons.
When Blount’s disease is left untreated not only a progression of the deformity will be seen, but patients will be at increased risk of joint arthritis of the knee & early degenerative changes.
Treatment of Blount’s disease largely depends upon age factor of the child & also its severity, but physical therapists can provide help during all stages. Physical therapy is an essential part of treatment. Patients should continue this two to three times a week even after leaving the hospital. Physical therapy aids ensure that the nearby delicate tissues stay adjustable as bones heal & that strength of the muscle is maintained. In case braces are recommended, physical therapists can teach parents how to carefully put on & take off the child’s brace.
Failure to properly treat Blount’s disease may result in progressive deformity. This condition may lead to differences in length of legs & cause permanent disability if not taken care of. Blount’s disease may also recur after surgery, notably in younger children. Parents should contact pediatric orthopedists if the child’s leg or legs seem to be bowing. Also, parents should keenly observe & promptly consult a doctor if child’s legs appear to be getting worse day by day even after treatment or surgery.
Most kids especially teens who undergo surgery as treatment for Blount’s disease soon experience themselves performing normal activities, even competing for sports. One lesson parents should take away from dealing with Blount’s disease in kids is the necessity of maintaining weight within a healthy range. Staying at balanced & healthy weight can help protect child’s joints & bones from excessive wear & tear that can impair them over time. In case parents would want help figuring out how to begin on a safe diet & exercise plan for the child, they should talk to the respective pediatric orthopedists.
Following are some of the main benefits of surgery for Blount’s disease.
- Minimizes discomfort experienced by children
- Corrects instability in the knee
- Rectifies limb length discrepancy
- Normal functioning of legs
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