Tibia vara: A complication of adolescent obesity

doi:10.1016/S0022-3476(05)81811-6

The Journal of Pediatrics

Volume 121, Issue 3, September 1992, Pages 482-486

https://doi.org/10.1016/S0022-3476(05)81811-6 Get rights and content

Tibia vara is characterized by inhibited growth of the medial portion of the proximal tibial growth plate, leading to progressive bowleg deformity. Twenty-nine adolescent patients with this condition were reviewed: all were black, 27 (93%) were male, and 19 (66%) had only one side affected. Progressive deformity rather than knee discomfort was the most common presenting complaint. The deformity reportedly developed rapidly during the adolescent growth spurt. The body weights of these patients exceeded the 95th percentile for age and gender by an average of 43 kg. The absence of significant symptoms and a body habitus that obscured the deformity often resulted in delayed diagnosis. Physicians involved in the care of obese black male adolescents should carefully examine them for tibia vara, which has a reported prevalence of 2% to 3% in this population. Treatment options are severely restricted if the condition is not diagnosed early.

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Obesity is a major risk factor for SCFE, which is the displacement of the capital femoral epiphysis from the femoral neck.38 Tibia vara is characterized by bowed legs and tibial torsion due to abnormal growth of the tibial growth plate in obesity, secondary to increased weight.39 Obese children also have reduced bone mass compared to normal weight peers and are at an increased risk for fractures.40
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Growing pediatric patients have musculoskeletal conditions that require unique attention in the obese population. Obese youth are susceptible to conditions such as tibia vara (Blount disease),24,25 a disorder of the musculoskeletal system in which the effects of weight on the growth plates leads to abnormal development of the bones with a bowing of the legs that worsens as the child develops. Additionally, obese children sustain altered patterns of injury compared with their nonobese peers after traumatic insult.26
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Obesity may cause orthopedic problems not only during childhood but may also have long-term implications for musculoskeletal health during adolescence and into adulthood. Anthropometric characteristics, particularly body mass, have been identified as important factors for the development and progression of foot deformities [3,4], varus/valgus angular deformities of the knee [3,5,6], slipped capital femoral epiphysis [3] and have long term implications for developing osteoarthritis (e.g. [7–10]). However, only few studies investigated the interrelation of these factors during dynamic activities in obese persons and particularly in obese children.
Anthropometric characteristics, particularly body mass, are important factors in the development and progression of varus/valgus angular deformities of the knee and have long-term implications including increased risk of osteoarthritis. However, information on how excessive body weight affects the biomechanics of dynamic activities in children is limited. The purpose of this study was to test the hypothesis that during stair-walking lower extremity joint moments normalized to body mass in obese children are greater than those in normal-weight children. Eighteen obese children (10.5 ± 1.5 years, 148 ± 10 cm, 56.6 ± 8.4 kg) and 17 normal-weight children (10.4 ± 1.3 years, 143 ± 9 cm, 36.7 ± 7.5 kg) were recruited. A Vicon system and two AMTI force plates were used to record and analyze the kinematics and kinetics of ascending and descending stairs. Significant differences in spatio-temporal, kinematic and kinetic parameters during ascending and descending stairs between obese and normal-weight children were detected. For stair ascent, greater hip abduction moments (+23%; p = 0.001) and greater knee extension moments (+20%; p = 0.008) were observed. For stair descent, smaller hip extension moment (−52%; p = 0.031), and greater hip flexion moments (+25%; p = 0.016) and knee extension moments (+15%, p = 0.008) were observed for obese subjects. To date, it is unclear if and how the body may adapt to greater joint moments in obese children. Nevertheless, these differences in joint moments may contribute to a cumulative overloading of the joint through adolescence into adulthood, and potentially result in a greater risk of developing knee and hip osteoarthritis.
Obesity and obesity-associated complications
2011, Revista Medica Clinica Las Condes
La obesidad ha aumentado en forma alarmante en los niños y adolescentes, e influyen en esto factores genéticos y ambientales. El índice de masa corporal es un método simple y rápido para hacer el diagnóstico. Cada vez con mayor frecuencia, las enfermedades asociadas a la obesidad están apareciendo a edades más tempranas. Las implicancias sociales y emocionales del sobrepeso son inmediatas y afectan la calidad de vida del adolescente, independiente de los efectos sobre la salud física.
El tratamiento no es fácil y debiera estar enfocado en la dieta, la actividad física, cambios de conducta y requiere del compromiso y cambios de hábitos de toda la familia.
Todo orienta a decir que la solución para la epidemia de obesidad está en la prevención.
The current increase in childhood and adolescence overweight and obesity reflects the convergence of genetic and environmental factors. Body mass index is a quick and easy way to screen for chilhood overweight. With increasing frecuency serious medical sequelae of obesity have their onset during childhood rather than the adult years. The social and emotional factors of overweight are immediate and influence many aspects of adolescent wellbeing independent of their physical health effects.
The treatment is not easy and should focus on diet, physical activity and behavior modification and needs family support and lifestyles change involving the whole family. The solution for the current epidemic of obesity seems to be the prevention.
Obesity in pediatric orthopaedics
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Citation Excerpt :
Adolescent Blount disease is less common than the infantile form, and the incidence is higher in the male sex; yet, African Americans who are morbidly obese comprise more than 90% of the reported cases.48 One study found the prevalence of adolescent Blount disease to be 2.5% in obese male adolescents.55 There were theories that the adolescent form was due to massive weight gain during adolescence in individuals with underlying varus alignment that could lead to excessive medial compartment loading and altered physeal growth (Fig. 3A).48
Effects of Pediatric Obesity on Joint Kinematics and Kinetics During 2 Walking Cadences
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Citation Excerpt :
The increased knee abductor moments unevenly distribute force across the medial compartment of the knee and create an increased risk of genu valgum, a condition common among obese children.5 Although less common than genu valgum, if the child is predisposed to varus alignment, an increase in knee adductor moment could increase compressive load on the lateral compartment and result in tibia vara, a condition predominantly found in patients with BMI values above the 95th percentile for age and sex.5,21-27 Increased absolute peak joint moments in the sagittal and transverse planes on the knee can increase the force with which tibiofemoral contact is made during the screw home mechanism.28
Shultz SP, Sitler MR, Tierney RT, Hillstrom HJ, Song J. Effects of pediatric obesity on joint kinematics and kinetics during 2 walking cadences.
To determine whether differences existed in lower-extremity joint biomechanics during self-selected walking cadence (SW) and fast walking cadence (FW) in overweight- and normal-weight children.
Survey.
Institutional gait study center.
Participants (N=20; mean age ± SD, 10.4±1.6y) from referred and volunteer samples were classified based on body mass index percentiles and stratified by age and sex. Exclusion criteria were a history of diabetes, neuromuscular disorder, or recent lower-extremity injury.
Not applicable.
Sagittal, frontal, and transverse plane angular displacements (degrees) and peak moments (newton meters) at the hip, knee, and ankle joints.
The level of significance was set at P less than .008. Compared with normal-weight children, overweight children had greater absolute peak joint moments at the hip (flexor, extensor, abductor, external rotator), the knee (flexor, extensor, abductor, adductor, internal rotator), and the ankle (plantarflexor, inverter, external/internal rotators). After including body weight as a covariate, overweight children had greater peak ankle dorsiflexor moments than normal-weight children. No kinematic differences existed between groups. Greater peak hip extensor moments and less peak ankle inverter moments occurred during FW than SW. There was greater angular displacement during hip flexion as well as less angular displacement at the hip (extension, abduction), knee (flexion, extension), and ankle (plantarflexion, inversion) during FW than SW.
Overweight children experienced increased joint moments, which can have long-term orthopedic implications and suggest a need for more nonweight-bearing activities within exercise prescription. The percent of increase in joint moments from SW to FW was not different for overweight and normal-weight children. These findings can be used in developing an exercise prescription that must involve weight-bearing activity.

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Tibia vara: A complication of adolescent obesity

Clinical basis for a mechanical etiology in adolescent Blount's disease

Orthopedics

Tibia vara: osteochondrosis deformans tibiae

J Bone Joint Surg [Am]

Late-onset tibia vara: a histopathologic analysis—a comparative evaluation with infantile tibia vara and slipped capital femoral epiphysis

J Pediatr Orthop

Lateral widening of epiphyseal plates in knees of children with bowed legs

AJR Am J Roentgenol

Tibia vara (osteochondrosis deformans tibiae): a survey of seventy-one cases

J Bone Joint Surg [Am]

Adolescent tibia vara associated with slipped capital femoral epiphysis: a report of two cases

J Bone Joint Surg [Am]

Transepiphyseal plate osteotomy for severe tibia vara in children: follow-up study of four cases

J Pediatr Orthop

Late-onset tibia vara: a comparative analysis

J Pediatr Orthop

The evolution and histopathology of adolescent tibia vara

J Pediatr Orthop

Normal axial alignment of the lower extremity and load-bearing distribution at the knee

Clin Orthop