Idiopathic tibia vara (or physiologic bow legs) is a relatively common, self-limiting deformity in childhood. It is a source of significant parental anxiety, for which they often seek medical attention. Frequently, the patient is accompanied by a grandparent who had been, or knows of acquaintances who had been, treated in braces or orthotics. Rather overtreated.
In contrast to physiologic bowing, William P. Blount gave the first comprehensive description of “Osteochondrosis deformans tibia,”- a progressive developmental deformity of the tibia, which, if left untreated, could lead to growth disturbances around the proximal posteromedial tibia, permanent deformity, and osteoarthritis. This deformity is better known as Blount disease. Based on the age of onset and distinct features, the condition has been categorized by Blount into an infantile and an adolescent form. In 1964, Langenskiold and Riska described the progressive stages of the condition, which may carry prognostic value. A patient diagnosed in later stages would frequently need more extensive surgery like physeal bar resection, compared to one diagnosed in earlier stages; this underscores the importance of timely diagnosis and vigilance on the part of the treating physician. An early surgery is often considered to be a conservative approach in the treatment of Blount disease.
Although the cause of Blount disease is unknown, its association with obesity has been established. With the increase in childhood obesity worldwide, the prevalence of Blount disease is expected to rise. Dr Sabharwal provides the readers with an update on the latest developments related to Blount disease, including the effect of overweight on the developing physis, the role of multiplanar deformity analysis, perioperative considerations, and surgical treatment options for correction of complex deformities.