Orthotic variations in the management of infantile tibia vara and the results of treatment

Abstract

Background: Infantile tibia vara is an acquired form of tibial deformity associated with tibial varus and internal torsion. Several methods have been described for orthotics treatment. The purpose of this study was to determine the effectiveness of orthotics treatment in infantile tibia vara. Study design: Controlled trial. Objective: The aim of this study was to compare the effect of different types of orthoses and correction methods on decreasing the curve in children with severe genu varum. Methods: Three different types of knee-ankle-foot orthoses were applied to 35 lower extremities of 22 pediatric participants who were 19-38 months of age. The same orthotic design principles were used to correct the femur, while different designs were applied to correct the tibia. The orthoses used on 20 participants were evaluated for differences among them and their effects on the treatment process. In addition, methods used in the treatment, problems encountered, production of different types of orthoses, convenience of application of the orthoses, and degree of patients satisfaction are discussed in this article. Results: The mean duration of treatment of the participants until completion of treatment was 25.3 ± 9.7 weeks with a minimum of 9 weeks and a maximum of 41 weeks. No statistically significant correlation was found between the duration of orthotic use in patients with a successful outcome and percentile height and percentile weight. When the duration of treatment using the different types of orthoses was analyzed, significant differences were found between Type 1 and Type 2, and Type 1 and Type 3 orthoses (p < 0.05), while no difference was observed between Type 2 and Type 3 orthoses (p > 0.05). Conclusion: We found that bracing is an effective form of treatment for infantile tibia vara up to 38 months of age. We conclude that full-time use of knee-ankle-foot orthoses exerting corrective forces from five points along the full length of the limb was effective. Clinical relevanceThe localization of the distal tibial correction, the quality of the midtibial correction band, and the importance of the application of corrective forces from five points with rigid methods were found.

Juvenile blount disease related to obesity in a 6-years-old girl

“…Radiographs are necessary for diagnosis. 5,6 The studies have identified a linear correlation between infantile Blount disease and body mass index (BMI). There has been an increase in the incidence of this disease, which in parallel to the rise of obesity rates in children.…”

Orthosis Effects on the Gait of a Child with Infantile Tibia Vara

“…Nonsurgical treatment of ITV has been somewhat controversial. However, recent studies have reported success when knee-ankle-foot orthosis (KAFO) was used nearly full-time to improve biomechanics in patients under 4 years of age [ 14 – 16 ]. The effectiveness of orthoses with corrective forces and/or distraction systems is related to their ability to relieve weight bearing stresses on the medial physeal region of the proximal tibia.…”

Improved Gait Parameters After Orthotic Treatment in Children with Infantile Tibia Vara

“…The sole of the foot usually lies flat on the ground during the stance phase, despite varus deformity due to concomitant talocrural joint deformity combined with medial rotation of the leg bones 10 .The nonsurgical treatment of ITV has been controversial. However, recent studies have indicated success when a knee ankle foot orthosis (KAFO) was used nearly full-time to improve biomechanics in patients aged <4 years [11][12][13] . The efficacy of orthoses with corrective forces and/or distraction systems is related to their ability in relieving weight-bearing stresses on the medial physeal region of the proximal tibia.Alsancak et al reported that a single upright KAFO with a drop lock knee joint was effective for the treatment of ITV in 20 children aged up to 38 months 11 .…”

“…The nonsurgical treatment of ITV has been controversial. However, recent studies have indicated success when a knee ankle foot orthosis (KAFO) was used nearly full-time to improve biomechanics in patients aged <4 years [11][12][13] . The efficacy of orthoses with corrective forces and/or distraction systems is related to their ability in relieving weight-bearing stresses on the medial physeal region of the proximal tibia.…”

“…The orthoses applied five constant corrective forces to the femur and proximal tibia, and the lateral corrective band that was applied across the tibia produced a rigid column ( Fig. 1) 11 .…”