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normal LE varus dev
- newborn: pronounced varus of 10-15 degrees
- 12-18 months: gets to neutral thanks to wt bearing
- 3-4 yrs: vagus begins
- 5-7 yrs: reaches normal mild valgus of 5-9 degrees
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Blounts disease
- genu varum (bow legged) > 2 yrs old
- it's affects only the tibia ... so there's an in-toeing gait pattern
- these kids aren't born w congenital abnormalities
- Blount's affects the medial proximal tibial physis
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risk factors for blount's
- obesity
- early walking
- fam hx
-
diffy diag for blount's
- trauma
- OI
- rickets
- osteochondroma - dysplasia of growth plate
- metaphyseal chondrodysplasia - inherited disorder of bone growth
-
2 classifications of blount's, and basic differences
- infantile: < 5 y/o, most get it bilatterally, hits females more than males
- adolescent or late onset: 5-10 y/o, unilat, obese, boys > girls
-
gait w blount's?
- in-toe
- internal tibial torsion
- lateral knee thrust
-
blount's x-ray
- wedge shaped epipysis (varus angulation)
- irregular physeal line
- increased tibial-fem angle (the acute angle formed by drawing a line thru these bones)
- increased metaphyseal-diaphyseal (MD) angle -- >11 degrees is risky, >20 is confermed tibia vara
-
non-op tx for infantile blount's
- KAFO w medial strap (50-80% success)
- no good if MD anlge is >16
- useful only up to 3 yo
-
operative tx for infantile blount's
- >3 y/o
- proximal tibial osteotomy
- epipysidesis (growth plate obliteration)
-
tx for adolescent blount's
- non-op if it's not progressing
- if deformity's worsening -- proximal tibial osteotomy, epiphysiodesis, external fixation
-
external fixation for blount's?
- gives angular correction ni any plane
- corrects distal tib deformities
- allows limb lenghtening for LLD
- stable fram allows WBAT
- shortened hospital stay
-
goals of PT for blount's
- edema control
- stim bone grownt & healing
- ROM
- strenghtening
- nrom gait & function
- edu for pt and parents
-
post op blount's
- NWB for 6-8 wks w cast
- transfer training
- gait training
-
5 phases of limb lenghtening for blounts w external fixator
- I: inpatient - fram application and latency period
- II: home - lengthening
- III: home - consolidation
- IV: inpatient - frame removal
- V: home - post fram removal, bone maturation
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4 complications of external fixator for blounts
- neurovascular compromise
- compartment syndromes
- infection
- fracture
-
what can PT do during phase I?
- knee extension positioning
- kne and ankle AAROM and strenghtening - lifts, quad sets, press into towel
-
phase II PT
- optimize ROM, anti and then against gravity
- open and closed chain work for strenght
- optimize gait
- wt shift on a balance toy
- gait training and stairs, WBAT
-
phase III PT
- full ROM in all jts
- do lunges, squats, SLS
- indep gait, noAD
- indep functional mobility & play
-
phase IV PT
ROM, strenght, gait, crutch-training, edu
-
phase V PT
- PWB w crutches for 2 weeks
- AAROM gently and slowly
- after 4-6 weeks, WBAT w/o AD
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