Babies that get blount’s disease are more frequent in African-American girls, affecting both legs in majority of the cases. When it starts later in the child’s life, it’s the African-American boys that are moreso affected this time.

That being said, blount’s disease is pretty rare, with less than 200,000 affected by it in the USA.

Physiotherapists help children and families manage the symptoms of Blount’s disease at all stages by teaching a child learn to walk with assistive devices as well as customizing strengthening exercises to improve standing and walking abilities throughout their stages in life.

What is Blount’s Disease?

As shared earlier, blount’s disease is a growth disorder of the tibia (the lower leg bone), and individuals who has it will typically have a bowing of the leg below the knee joint. It can affect one or both legs.

In some cases, some kids can develop shortening on one leg (called as leg-length discrepancy) OR the turning of one or both feet inwards.

Blount’s disease is classified into 3 groups based on the age of the child:

• Infantile (birth to 3 years of age)
• Juvenile (4 to 10 years of age)
• Adolescent (11 years and older)

Infantile Blount’s disease occurs in children younger than 3 years of age, who started to walk early, are larger than their peers or are overweight.

For toddlers, the repeated strain and compression on the inner-and-top part of the shin bone damages and causes the growth plate to slow down their growth, whilst the outside part of the bone continues to grow — it’s this that causes the bowing of the bone in the lower part of the leg. Growth plates are special cartilage located at each end of a child’s long bones that helps children grow taller by building bone on top of bone.

There is “normal” bowing of the lower leg in infants who are developing normally typically sorts itself out by the time they’re 2 years old, but for kids who get blounts, it doesn’t get better and the bowing of the knee becomes obvious when they’re about 3 or 4 years old. By 7, their legs will unfortunately achieve a different shape, with the knees appearing to fall inward slightly…and by the age of 12, all children’s legs have grown into their adult shape. By now, the shape of the leg changes very little beyond this stage, although the bones and muscles continue to grow longer and thicker.

If the bowing is not typical, for example, it doesn’t have the shape of typical infant bowing AND/OR is unequal in the 2 legs or is extremely bent, then by now the doctor would suspect blount’s disease. If you’re not sure, quickly seek medical attention.

• Juvenile Blount’s disease affects children aged 4 to 10 years.
• Adolescent Blount’s disease affects children aged 11 and older.

These forms of the disease affecting older children are less common than the infantile form, and typically affect

• large / bigger teenagers
• boys more often than girls
• especially boys with a vitamin D deficiency

The upper and lower bones of the leg are often affected in both these forms of the disease.

The major difference between these two groups (juvenile and adolescent) is the age of the child when the bowing is noted, and how much growth the child has remaining. Physicians are able to use radiographs to estimate the amount of growth remaining.

What are the signs and symptoms

1. Blount’s disease may affect either one or both logs, and the most common symptom is a bowing from just below the knee to the ankle. The bowing tends to worsen over time and growth. In some older children, the thigh bone may also be affected as well.
2. Younger kids or toddlers with blount’s disease may not feel any symptoms, but the older kids (teenagers) may report pain on the inside of their knee joint and down the side of their affected leg.
3. Their walking will be affected as well, be it limping or frequent tripping (with or without falling)

How do you diagnose blount’s disease?

Blount’s disease is diagnosed with

1. physical examination by a doctor, typically a specialist be it a pediatrician or pediatric orthopedist and
2. by taking xray images of the legs

The physician will examine the patient’s legs and knees, as well as observe the way the patient ways. They may also measure the distance between the patient’s knees when standing with the feet touching.

If there is an unusually wider-than-normal space between the knees, then the physician will need to do further testing, such as order radiographic images because bowing of the bones can be seen more clearly on this type of image.

Radiographs will allow the physician to confirm the diagnosis (or not) and assign a severity from I to VI to indicate the stage of blount’s disease. Stage I is the mildest form and stage VI is the most severe form.

The physician may also request a blood test to determine the vitamin D level in the blood.

How physiotherapy can help

 

Treatment of Blount’s disease depends on the age of the child and the stage of the disease; and physiotherapy will help during all stages. If they’re younger than 2.5 years (30 months) and in the early beginning stages, they may be prescribed a special brace by the doctor:

• HKAFO (hip-knee-ankle-foot orthosis) or
• KAFO (knee-ankle-foot orthosis)

and their #1 goal is to redistribute the forces on the growth plate to foster normal growth. These braces are customized by an orthotist after casting and scanning the leg and knees and will need to be worn for about 2 years until the knees improve. It will be adjusted as the child grows. 

The physiotherapist will teach and help your child with stand, balance, walk and move around with the brace, including going up and down steps or ramps.

If corrective surgery for blount’s disease is required

If brace is unsuccessful and the child is older than 10 years old, then corrective surgery can be considered. With surgery, the surgeon can (or will) place a special fixator on the leg to be worn between 2 or 3 months.

In the hospital after surgery, the physiotherapist will teach your child how to walk using walker (or crutches) – figuring out to put the just right amount of weight onto the foot to avoid injury to the repaired knee.

The physios will also teach your kid specific customized exercises to build knee and leg strength and movements too. After discharging from the hospital, patients will need to continue physiotherapy for at least 2-3 times per week. 

Physiotherapy helps

• the surrounding leg tissues remain flexible as the bone heals
• muscle strength is maintained and improved
• a child is as independent as possible with all daily responsibilities and activities
• weight-bearing safety precautions are considered and taken at all times

It’s very normal for kids to be scared and hesitant even when the surgeon gives the go-ahead to put full bearing on the operated leg, and the physios will work with you and your kid to increase use of the affected knee and leg as much as possible.

Physios will also provide guidance and help with walking and strengthening for teenagers who diagnosed with Blount’s disease. As the adolescent’s natural growth occurs, the deformity may slowly improve and be corrected with practice and time; if not, then surgery may be considered.

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