A child uses the molded orthoses with three full contact points (thigh inner edge, outer edge of the proximal tibia, and distal inner edge of the tibia), promoting decompression on the medial proximal edge of the tibia.
Photograph courtesy of Acta Ortopédica Brasileira.
A study of the medical records of patients undergoing treatment of Blount’s disease with molded orthoses for medial decompression found that the nightly use of molded orthoses was effective in reducing the metaphyseal-diaphyseal angle in this population of children who are under three years of age, regardless of gender and bilateral presentation. Patients over three years old did not benefit from bracing. The study, conducted in Brazil, was published in the March-April issue of Acta Ortopédica Brasileira.
Patient medical records between 2010 and 2014 were evaluated, and the metaphyseal-diaphyseal angle and Langenskiöld classification were measured before and after treatment by a pediatric orthopedic surgeon with over five years of practice, blinded for the study and patients. The inclusion criteria was patients with confirmed diagnoses of Blount’s disease who were between two and five years old at the beginning of treatment and Langenskiöld stage I to IV. The mean patient age was 2.57 years old; four patients were female and six were male. Half of the sample was affected bilaterally.
The medial decompression orthoses were made by the occupational therapy team from low-temperature thermoplastic material molded directly onto the patient’s leg and had three full contact points. Thus, the orthosis applied forces at its proximal ends (positioned in the inner thigh), at the distal end of the tibia, and at the medial and lateral fulcrum located at the proximal lateral end of the tibia.
The patients’ caregivers were instructed that the orthosis was to be used overnight and daily for at least eight hours per day. Return appointments were scheduled at one week, three weeks, six weeks, and three months, in which the patient was assessed by medical and occupational therapy staff. The medical evaluation was aimed at improving adherence to treatment, as well as to follow the deformity clinically and radiologically. After the third month, post-operatory consultation returns were scheduled every three months. Panoramic radiographs of the lower limbs were indicated at each consultation from the third month. The proposed follow-up time was one year and may have been extended to two years if there was progressive improvement of the metaphyseal-diaphyseal angle. Each orthosis had an average cost of about US $35 and needed to be replaced every six months due to the child’s growth.
Orthosis use was effective in reducing the metaphyseal-diaphyseal angle, with statistical significance, according to the researchers. Gender and laterality did not statistically influence the change of the deformity angle after treatment. Only three tibiae (20 percent of the sample) showed no reduction of the deformity angle and two of them (13 percent) were from patients older than three years. Even without full correction (a varus deformity was maintained in most cases), only cases with worsened deformity underwent surgery on follow-up.
