Tibia vara ( blount disease)

 The medial portion of the upper tibial epiphyseal plate may become the site of a localized
epiphyseal plate growth disturbance known as tiba vara (blount disease, osteochondrosis
deformans tibiae) which is characterized by a progressive bow leg (varus) deformity.

This disorder is more common n girls than boys. It usually becomes manifest at the age of about 2
years in the infantile type and after the age of 8 years in the adolescence type. The growth
disturbance may involve only one tibia or both. Tibia vara is relatively uncommon in most areas of
the wold but is inexplicably common in two completely different types if country, namely, Finland
and Jamaica.

Once considered to be the result of a localized osteochondrosis of the medial portion of the upper
tibial epiphysis, tibia vara is now thought to represent a localized form of epiphyseal dysplasia. The
combination of diminished growth in the medial portion of the epiphyseal plate (physis) and
continued normal growth in the lateral portion accounts for the progressive angulatory deformity of
varus, that is, bow leg. After a number years, the medial portion of the epiphyseal plate closes
prematurely.

In the early stages of tibia vara, there are no symptoms. Examination reveals a chareacteristic varus
deformity of the knee, a deformity that is particularly striking when it is unilateral. Radiographically,
there is defective ossfication of the medial portion of the upper tibial epiphysis, a beaked
appearance of the underlying metapysis, and obvious retardation of longitudinal growth in the
medial side of the tibia,

Treatment in the early stages of tibia vara in young children is aimed at preventing progression of
the varus deformity. This can sometimes be accomplished by means of a night splint of the type
used for physiological bow legs. In older children, the varus deformity progresses despite splinting. It
can be corrected only by osteotomy of the tibia, which may have to be repeated on one or more
occasions during the remaining growth.

Bow legs

The most commin cause of bow legs in children is internal torsion and varys of the tibia with external
rotation of the femur. Thus, the common type of bow leg deformity is not simply the opposite of
knock knees. These combined deformities are frequently present at birth because of the intrauterine
position but usually improve spontaneously. However, they may even be increeased by the
aforementioned habitual position of sleeping abd sitting.

In more severe degres of persistent genu varus in children older than 2 years of age, it may be
necessary to use a specially designed night splint to correct varus elementin the tibia, while the
opposing torsional deformities in the femora are allowed to correct them selves spontaneously. Day
braces for bow legs are ineffectual, and osteoomy of the tibia is not necsary hfor this physiological
type of bow leg in young children.