This 1987 narrative review from the Mayo Clinic synthesizes the English literature on Blount disease (tibia vara). It covers both the infantile and adolescent forms, addressing epidemiology, etiology, pathogenesis, classification, diagnosis, and treatment. The review provides a comprehensive reference for evaluating and managing pediatric patients with progressive proximal tibia vara.
When you see a toddler with persistent genu varum, the key question is whether this is physiologic bowing or early Blount disease. The tibiofemoral angle will not answer that question.
Measure the metaphyseal-diaphyseal angle: values >11° mandate close radiographic follow-up for Blount disease, even if plain films look benign. Physiologic bowing will also show angular changes at the distal femur and distal tibia — true Blount disease does not.
When Blount disease is confirmed, Langenskiöld stage, patient age, and degree of varus all drive management. Osteotomy alone works for stages I–IV; stage V–VI or patients older than 8–9 years need combined procedures (epiphysiodesis or bar resection) to prevent recurrence. Operate before age 5 if possible.
Do not underestimate the complication profile of tibial osteotomy in children. Up to 63% of patients in one series had at least one complication. Counsel families accordingly, and ensure correction reaches neutral alignment, since undercorrection is a primary driver of recurrence.
This 1987 narrative review from the Mayo Clinic synthesizes the English literature on Blount disease (tibia vara). It covers both the infantile and adolescent forms, addressing epidemiology, etiology, pathogenesis, classification, diagnosis, and treatment. The review provides a comprehensive reference for evaluating and managing pediatric patients with progressive proximal tibia vara.
When you see a toddler with persistent genu varum, the key question is whether this is physiologic bowing or early Blount disease. The tibiofemoral angle will not answer that question.
Measure the metaphyseal-diaphyseal angle: values >11° mandate close radiographic follow-up for Blount disease, even if plain films look benign. Physiologic bowing will also show angular changes at the distal femur and distal tibia — true Blount disease does not.
When Blount disease is confirmed, Langenskiöld stage, patient age, and degree of varus all drive management. Osteotomy alone works for stages I–IV; stage V–VI or patients older than 8–9 years need combined procedures (epiphysiodesis or bar resection) to prevent recurrence. Operate before age 5 if possible.
Do not underestimate the complication profile of tibial osteotomy in children. Up to 63% of patients in one series had at least one complication. Counsel families accordingly, and ensure correction reaches neutral alignment, since undercorrection is a primary driver of recurrence.