Blount’s disease, also known as Blount’s syndrome, Blount’s disease or Erlacher-Blount syndrome, refers to impaired growth of the inner lower leg bone (the tibia). This results in an arcuate deformation of the bone, which is usually manifested by a bend just below the knee. In more than half of those affected, both legs are deformed.
What is Blount’s disease?
Blount’s disease or Blount’s syndrome refers to a defective growth of the inner lower leg bone. This malformation usually results in an arcuate deformity or even bending of the bone. In most cases, a bend or arch is also formed directly below the knee. Furthermore, patients suffering from Blount’s disease are often conspicuous by different lengths of the lower limbs and by a very conspicuously protruding tibia. Very often, Blount’s syndrome occurs as early as infancy, but is not noticed until later – for example, at elementary school age. In addition, a distinction is made between two types: the infantile and the adolescent (delayed) form. The former form occurs predominantly in children under ten years of age and affects both legs. The latter form often affects adolescents, clustered on only one leg. However, in about 60 percent of cases, both legs of the patient are affected. The actual frequency (prevalence) of the syndrome is not yet fully known. But: Blount’s disease is considered relatively rare and occurs clustered in South African states.
Causes
According to various experts and studies, Blount’s disease is often promoted by obesity and/or by running at a fairly early age. Furthermore, premature closure or even narrowing of the medial growth plate of the lower leg bone is often suspected. In this case, the forces acting on the growth plate, for example during running, are too great – deformation occurs. Nevertheless, there seem to be several factors that can favor a deformation of the upper part of the tibia. The role that genetic predispositions may play is unknown to date.
Symptoms, complaints, and signs
Blount disease is fundamentally manifested by a unilateral or bilateral deformation or even bending of the lower leg bone. In medicine, it is usually referred to as a deformity of the upper portion of the tibia. A distinction is made between an early form and a late form. The former very often affects overweight children under the age of ten. The late form occurs more frequently in adolescence and usually only on one side – however, the disease is rarely diagnosed here after the age of 15. Incidentally, legs that are deformed due to Blount’s syndrome are often referred to as “bow legs”. The affected children usually do not feel pain, but if not treated, the deformity can lead to severe impairments later on.
Diagnosis and progression
Blount disease usually cannot be successfully diagnosed until after the second year of life, because a slight O-shape of the legs is difficult to see in very young children. In addition, since affected children usually experience no pain and (at the beginning) no impairment, the disease is also often not noticed until somewhat later. Clinically, affected children are usually noticed between the ages of two and ten due to visible “bow legs”. If it is suspected that a patient suffers from Blount’s syndrome, this suspicion is confirmed or dispelled by various examinations such as X-rays. Incidentally, without treatment, the deformity of the limbs can take on severe proportions and lead to discomfort or secondary diseases such as arthritis of the knee joints at a fairly early stage.
Complications
Blount disease usually results in deformity of the legs. However, both do not have to be affected; in many cases, deformities and malformations also occur on one side. In these cases, the lower leg bone in particular is severely bent, so that movement is restricted by Blount’s disease. The patient’s mobility is limited and he is dependent on walking aids. This can lead to psychological problems and reduced self-esteem. Only in rare cases does Blount’s disease cause pain.Unfortunately, diagnosis of the disease is possible only from the second year of life, so that delayed treatment occurs. The treatment itself depends on the limitation of the symptoms. In this case, there are no further complaints or complications. Usually splints are used, which are worn for several years and are intended to straighten the bow legs. Physiotherapies can also limit Blount’s disease and relieve the symptoms. In many cases, the patient must engage in athletic activities to counteract the disease. Life expectancy is not reduced by Blount’s disease. If pain is experienced as a result of the deformities, surgical procedures may be performed.
When should you see a doctor?
Parents who notice bowlegs in their child should consult their family doctor immediately. Although the deformity of the legs is not always due to Blount’s disease, it must be treated in any case. If it is indeed Blount’s disease, treatment is required. It is therefore advisable to talk to the doctor at the first sign of a malposition. Medical advice is needed at the latest when the child complains of pain or has problems with normal movements. If Blount’s syndrome remains untreated, secondary diseases such as arthritis of the knee joints or chronic pain can develop. Typical warning signs of such a severe progression include loss of strength and swelling and stiffness of the knee joints. If one or more of these symptoms is noticed, the rule is: see your family doctor immediately and arrange for an examination. In its early form, Blount’s disease can be treated with orthopedic measures. Later, surgical interventions and lengthy physiotherapeutic measures are required. Therefore, the disease should be diagnosed and treated early.
Treatment and therapy
If a diagnosed Blount syndrome is present, orthopedic treatment must be specifically adapted to each child and each clinical picture. This is because successful therapy depends primarily on the type, the extent of the disease, and the deformity of the or the lower leg bone. Overall, however, Blount’s disease is treated quite conservatively with splints. Depending on the extent of the disease, these have to be worn for a few weeks or months, in some and rather few cases for a few years. In addition, various orthopedic measures (special sports exercises and more) can accompany and optimize the therapy. Only in a few, more severe, pronounced and/or painful cases of the disease, surgical correction of the deformities is necessary. This is more often necessary in the late form of the disease than in the early form.
Outlook and prognosis
The prognosis for Blount disease can vary widely. It depends on the severity of the deformities and on when the diagnosis is made. For example, in children who are diagnosed with this malformation of the legs, it is the case that a good outcome can be achieved by means of conservative therapy with splinting. This is due to the fact that children are still growing and respond correspondingly better to a targeted external effect on bone growth. Splinting can last for months or years. It is nevertheless possible that complications – i.e. recurrent deformities of the lower legs – may occur later in life. If Blount’s disease is diagnosed later, splinting may also be appropriate. However, in this case the leg cannot straighten, so conservative therapy is supplemented with special exercises. Surgical intervention becomes more necessary for treatment the later the problem is detected. Left untreated, Blount’s disease leads to a number of complications that include pain, perceived instability and more. Walking aids and generally limited movement are the result. However, the life expectancy of affected individuals is not reduced, and in most cases it is possible to support the body with orthopedic measures.
Prevention
Since the interaction of the individual causes and the extent to which genetic predispositions play a role in Blount’s disease has not been completely clarified to date, it is difficult to prevent a, deformation of the lower leg bone.However, since according to various studies and experts, children who are overweight and started walking early are often affected, parents should pay increased attention to these two factors. If there is any uncertainty, it is advisable to consult a doctor immediately. If a disease is suspected or can be diagnosed, the doctor can initiate therapy at an early stage – for example, by having splints fitted or prescribing further orthopedic measures. In this way, a deformity of the upper part of the tibia may not always be avoided, but its effects can be kept within limits. However, prohibiting the child from walking for fear of developing the condition, perhaps because parents or siblings are or were affected, is not a good way to prevent it.
Follow-up
For Blount disease, follow-up care also focuses on physical therapy. Physiotherapy and regular exercise can stabilize the mobility of the affected lower leg bone. Massages and measures from alternative medicine, for example acupuncture, can additionally support recovery. Medical aftercare focuses on progress checks. These initially take place monthly and then every six months. However, depending on the type and severity of Blount’s syndrome, the frequency can vary greatly. Therefore, patients should consult closely with their physician. This is also important with regard to any complications, which should be reported to the physician as soon as possible. In the case of bilateral Blount’s syndrome, further follow-up examinations may be necessary. For example, it must be checked whether the condition has led to deformities and consequently to joint wear and other complaints. If this is the case, therapy with painkillers must be continued. In addition, further physiotherapeutic measures are necessary. Blount’s disease in young children can be treated effectively. Follow-up care must usually be continued for several years, but should resolve in the long term. If the disease persists into adulthood, complete recovery cannot be assumed. Then curative measures are also performed during follow-up care to improve the patient’s quality of life.
Here’s what you can do yourself
Affected individuals with Blount disease sometimes go through a severe course of the disease, but they can be treated well with orthopedic measures. Some self-help measures can accompany and optimize orthodox medical treatment. Above all, physical exercises such as yoga, Pilates or classical physiotherapy are recommended. In particular, the arch muscles of the foot should be regularly exercised and stretched – for example, by repeatedly lifting the toes and other stretching exercises from sports. After a diagnosis of Blount’s disease, a general change in lifestyle is often useful as well. With a healthy body weight and an all-around well-supplied organism, bow legs and their consequences can at least be contained. Those affected are recommended to use a diet plan, which is best worked out in cooperation with the attending physician or a nutritionist. The specialist can also provide tips against the characteristic pain. In addition to the classic medicines, medicinal plants such as willow bark or peppermint are also suitable here, for example. Finally, it is important to talk to the doctor regularly and to take advantage of accompanying therapeutic measures at an early stage. Therapeutic advice and participation in self-help groups can also reduce the psychological discomfort that can be associated with Blount’s disease.