Child Orthopedics

Frequently Asked Questions

Our two-year-old was just diagnosed with Blount disease. If they catch this problem early, does it mean the results will be good?

Blount disease looks like bowlegs also known as tibia varum (singular) or tibia vara (plural). Bowlegs are common in toddlers and young children. The condition is called physiologic tibia varum when it's a normal variation and the child will grow out of it. Most toddlers have bowlegs from positioning in utero (in the uterus). This curvature remains until the muscles of the lower back and legs are strong enough to support them in the upright position. In some cases, abnormal growth of the bone causes the bowing to get worse instead of better over time. This is the condition we call Blount disease or pathologic tibia varum. Blount disease becomes obvious between the ages of two and four as the bowing gets worse. Overweight adolescents or teenagers can also develop this problem. Blount disease is more than just a cosmetic deformity. is affected. In the early stages of this condition, the medial or inside edge of the bone breaks down and growth stops. Pain develops along with an uneven leg length, which can lead to an altered gait (walking) pattern, tripping, falls, and injuries. What can be done about it? Treatment depends on the age of the child and the stage of the disease. Between ages birth and two, careful observation or a trial of bracing (also called orthotics may be done. If the child doesn't receive treatment, Blount disease will gradually get worse with more and more bowlegged deformity. Surgery may be needed to correct the problem. For the obese child, weight loss is helpful but often difficult. Surgical correction may be needed especially for the younger child with advanced stages of tibia varum or the older child who has not improved with orthotics. Surgery isn't usually done on children under the age of two because at this young age, it's still difficult to tell if the child has Blount disease or just excessive tibial bowing. Between the ages of two and four, it becomes more obvious if the child has a true case of Blount disease and not just a normal anatomical variation that will get better with time. This type of Blount disease is referred to as infantile Blount. Studies show that children with infantile Blount tend to have a higher rate of recurrence after surgical correction. Many require more than one surgery. When limb length differences occur, surgery is done to correct the increased angle and to lengthen the bone. It's a gradual process that may require long-term surgical intervention.

Sylvan E. Clarke, MD, et al. Treatment of Blount Disease. A Comparison Between the Multiaxial Correction System and Other External Fixators. In Journal of Pediatric Orthopaedics. March 2009. Vol. 29. No. 2. Pp. 103-109.

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