Archives for: July 2002, 09
Dear Pam ~ Thank you for writing to me, and I hope I can be of some little help to you. Infantile Blount's disease (infantile tibia vara) is a condition that NOTHING in your diet during pregnancy or nursing could POSSIBLY have had ANYTHING to do with! I want to emphasize that you could not have done anything differently that would have precluded your daughter's condition. You are NOT AT FAULT in any way. You have done the absolute best things for her, and for yourself. This is most likely a genetic disease, for which no test is possible until the baby is born and shows symptoms.
An interesting note in regard to your concern: http://www3.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?259200.cs
-- indicates that this is an inherited disease (autosomal recessive), not multifactoral -- in other words, NOT a condition which your choice of food or exercise could have played any part in. These heart-wrenching things can happen with children -- it's part of what we risk in having them! -- and the parent's foremost responsibility and concern now is to realise that NOW is the only time that matters. NOW is when you can do the best thing for your child. :-)
I've been reading about Blount's for months now, hoping to find an alternative/complementary medical strategy to alleviate it. The good news is, now that your daughter is 24 months old, this is an excellent time for the first interventions.
Following are the references I found useful in understanding this condition and the best approaches to resolve it.
-- a simple explanation from an Illinois Pediatric Institute
-- specifics from a pediatrics site in hawaii:
"Blount's Disease is a major cause of angular
deformation in children. It is also called infantile tibia
vara and results from some problem with the growth of
the posteriomedial aspect of the tibial physis.
Physiologic bowing usually has resolved by age 3, but
Blount's disease advances to more severe angulation.
Bracing is needed for those children between 14 and 30
months if the metaphyseal-diaphyseal angle is 9 to 16
degrees and the knee is unstable when walking."
-- 5 minute consultations (http://www.bayviewortho.com/Referrals/Consultant/5minconsult.html#Blounts Disease) says:
"Blounts Disease -- by Jennifer Lindsey
Description: Abnormality of the proximal tibial growth plate causing excessive varus alignment of the knees (bowed legs) in children.
Appropriate Care: Children presenting under 3 yrs of age with minimal deformity can undergo a trial of bracing. This should be a long brace from hip to ankle locked at knee. Most orthoapedists recommend this be worn day and night. If bracing fails to correct the deformity, or if the patient presents with moderate - severe deformity and age over 3 yrs, a realignment procedure is needed."
-- According to http://www.healthchecksystems.com/tchild.htm, primarily concerned with body composition (fat/muscle) in children,
"In a study of Blount's disease (severe bowing of the legs) approximately 80% of patients were obese."
I wish they'd provided the study.
-- a technical orthopedic site: http://gait.aidi.udel.edu/res695/homepage/pd_ortho/educate/clincase/blount.htm
-- Surgery after a certain age is not completely effective:
-- Here are some very recent surgical recommendations/results based upon Langenskiöld's procedures (this is highly technical -- take it to your orthopedic pediatrician):
-- More recommendations and specific advice from http://www.pediatric-orthopedics.com/Topics/Bow_Legs/bow_legs.html boils down to:
-- bracing ASAP is indicated, along with carefully targeted xrays of the entire hip/leg/ankle/foot. 24 months is an ideal time to do so, in order to avoid surgery.
-- From the highly technical "limblengthening news" site (more stuff to cut & paste for your orthopedic pediatrician):
"While there is a general consensus that correction of the varus deformity in Blount's disease is desirable, there have been many methods advocated. These include open or percutaneous osteotomy in the metaphysis of the proximal tibia, opening or closing wedge correction, acute or gradual correction, stabilization with internal or external fixation, and opening wedge correction through the proximal tibia physeal area. The use of a percutaneous osteotomy in the metaphysis and gradual correction of a large deformity with an external fixator has many advantages. The osteotomy is minimally invasive and does not require extensive soft-tissue stripping, improving the bony healing potential. Complications of osteomyelitis, wound dehiscence, and large keloid scar formation should be less likely. Benefits of the use of external fixation as the method of stabilization are that it allows increased weight bearing and lateral translation of the distal fragment along with the angular correction. Another benefit is the feature of postoperative adjustability after a standing hip to ankle radiograph is obtained and the mechanical axis analysis is performed. The use of a gradual correction may decrease the likelihood of neurovascular insult and compartment syndrome particularly in a patient with a massive deformity as in the current report. Gradual correction should be relatively safe in a Blount's disease patient with a massive varus deformity along with procurvatum and internal tibial torsion. Another advantage of gradual correction with a frame is the possibility for limb lengthening if needed to correct length discrepancy. Opening wedge correction prevents further shortening and loss of bone stock."
Now, what I think is this:
In terms of diet, give her plenty of homemade chicken or turkey soup/bone broth and steam & chop or blend into it some dark greens like kale or collards. Include Phytocal-A in some soft food (open the capsule and mix it in). Use powdered seaweed in her food instead of salt. Give her mineral water (you know my penchant for Gerolsteiner -- buy the fizzy variety if necessary, just shake it/open it/shake it/open it... let it go flat). Let her have little slurps of walnut butter, almond butter. Make fruit smoothies with them if you like. Cook beneficial beans for her, and include steamed, mashed okra for those great polysaccharides and minerals.
In terms of medical treatment, get braces for her legs right away. I know this idea makes you weep, but she is exactly at the right age to benefit from this method. This means alone can save her from the more invasive methods of internal/external frame support correction or surgery.
Pam, my prayers are with you and your little girl. Please keep me posted on what you're doing and how she is responding. If you ever catch yourself blaming yourself for her path, just imagine me standing there shaking my finger at you and saying, WHAT DID I SAY ABOUT THAT?? Obstacles create warriors, my dear -- adult and child. Blessings, and keep me up to date!