Management of Infantile Blount's Disease With Molded Orthoses: A New Perspective

Luzo, Maria Cândida de Miranda; Montenegro, Nei Botter; Massa, Bruno Sérgio Ferreira; Angeli, Luiz Renato Agrizzi de; Cordeiro, Felippi Guizardi; Guarniero, Roberto

doi:10.1590/1413-785220162402153725

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…In some sources, the treatment duration of orthosis in ITV is suggested as a wider period ranging between 7 weeks and 2 years. Besides, the early period with the first signs of recovery is seen in the 3rd month 2 , 14 , 15 . Similarly, in this study, the effects of orthosis in the first period on children with ITV were investigated.…”

Section: Discussionmentioning

confidence: 98%

“…Lower spontaneous recovery rates and these patients seeking surgery in the absence of recovery are risks of waiting for spontaneous recovery. However, the success of orthosis in treatment is higher with the identification of eligible patients in the early stages 2 , 14 , 15 , 31 . For these reasons, a spontaneous recovery group was not established in our study, and the early outcomes of orthosis supported its effectiveness in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is not performed as widely as surgical treatments 13 . In several studies, it has been stated that orthosis shows positive developments in the knee joint 2 , 14 , 15 . Given the biomechanics of the musculoskeletal system, it is considered that ITV could affect the lower and upper segments.…”

Section: Introductionmentioning

confidence: 99%

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The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease)

Güven

Çıtaker

Alsancak

2023

Sci Rep

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Albeit some studies have revealed the effectiveness of the orthosis use in infantile tibia vara (ITV), hitherto no study has shown the effects of these orthosis on plantar pressures. This study aims to reveals the effects of orthosis on plantar pressure in infantile tibia vara. Fourteen children (mean age: 27.14 ± 5.00 months) with infantile tibia vara made up the study group and 14 healthy children (mean age: 26.42 ± 5.33 months) constituted the control group. The plantar pressure distribution was evaluated with WALKINSENSE. ITV group was evaluated before and after orthosis. The control group did not use orthosis and was evaluated once. After orthosis, it was determined that lateral foot pressure decreased, and medial foot pressure increased in the hindfoot. After orthosis, medial pressure decreased in the forefoot (p < 0.05). The pressure in the forefoot of the control group was significantly higher than that in the ITV group (before and after orthosis) (p < 0.05). After orthosis, the pressure was similar in the posterior and mid-foot sensors between the ITV group and the control group (p˃0.05). The orthosis can be effective in achieving the normalization of the soles pressure distribution in children with ITV.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease)

Güven

Çıtaker

Alsancak

2023

Sci Rep

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“…Surgical correction is required when patients fail bracing or present at an older age or with a more severe deformity [1,15,17]. Despite advances in the surgical treatment of Blount's disease, recurrence remains an issue, with reported rates as high as 88% [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Reliability of a New Classification System for Blount’s Disease

Jardaly

Conklin

Strom

et al. 2020

Cureus

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ObjectiveWe conducted this study to evaluate the reproducibility of a new classification system for Blount's disease and assess its correlation with established radiological measures used to evaluate the severity of this disorder. Materials and MethodsThis is a retrospective review of children with Blount's disease that were younger than 10 years of age. Recurrence was defined as the need for a second corrective surgery. Radiographs immediately pre-surgery and at final follow-up were used to measure mechanical axis (MA), tibial metaphyseal-diaphyseal angle (TMDA), epiphyseal-metaphyseal angle (EMA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). Patients were stratified according to the new classification (Type A, B, or C). ResultsSixty-five limbs from 16 males and 24 females met our inclusion criteria. The average follow-up was 4.2 years. Twelve patients (with 22 Type-A extremities) underwent bracing with a success rate of 54%. Thirtyfour patients (53 extremities) underwent surgical correction. The recurrence rate was 35.8%. Group C had a recurrence rate of 62%, higher than that of Group B (33%), and Group A (23%) (P = 0.026). In addition, irrespective of reoperation, patients in Group C had the least change in the MA (62%, P = 0.046) and the most severe values of MPTA and TMDA initially and after the operation (P < 0.05). ConclusionThe new classification system for Blount's disease holds validity for predicting recurrence. The severity of the grades is correlated with the TMDA, MPTA, and varus reversibility. This can aid physicians and families in making an informed decision and setting treatment goals.

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“…Their recommendations were for children between 1½–2 ½ years of age, worn during weight-bearing to decrease compressive forces, and if not corrected after one year to proceed with surgery [ 48 ]. Authors report limited success with bracing due to multiple factors including compliance and obesity [ 1 , 49 , 50 ]. Bracing is not indicated in stages III and higher as it is ineffective and delays surgery.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

Deformity Reconstruction Surgery for Blount’s Disease

Robbins¹

2021

Children

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Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient’s age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount’s disease.

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Management of Infantile Blount's Disease With Molded Orthoses: A New Perspective

Cited by 10 publications

References 26 publications

The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease)

The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease)

Prognostic Reliability of a New Classification System for Blount’s Disease

Deformity Reconstruction Surgery for Blount’s Disease

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