Effect of Lateral Single Bar Knee Orthoses in Correction of Genu Varum in Nutritional Rickets: A Randomized Trial

Abstract

Introduction: Genu varum is a common pediatric knee deformity and seen as a physiological variation in the growth pattern. Rickets causes more pathological bowing if occurs during the phase of physiological bowing. Apart from vitamin D restoration, the role of orthosis in the correction of the genu varum due to rickets is not clear. This study is done to compare the effect of vitamin D restoration with and without orthosis in correction of the genu varum in nutritional rickets. Materials and methods: Sixty children with a bilateral genu varum were enrolled as per inclusion and exclusion criteria and divided into two equal groups. Group I received the Stoss therapy for vitamin D restoration with bilateral lateral single bar knee orthoses, and group II received the Stoss therapy only. The intercondylar distance and radiographic tibiofemoral angle were measured at the beginning and for three follow-up visits at 2 monthly intervals. Results: The intercondylar distance and tibiofemoral angle decreased significantly (p ≤ 0.001) at subsequent follow-ups in each group. The percentage change in the intercondylar distance and the tibiofemoral angle at the subsequent follow-up on comparison in both groups was statistically insignificant. Conclusion: Lateral single bar knee orthoses do not provide any additional benefit over vitamin D restoration by the Stoss therapy for the treatment of the genu varum in nutritional rickets.

Non-Surgical Strategies for Managing Skeletal Deformities in a Child with X-Linked Hereditary Hypophosphatemic Ricket: Insights and Perspectives

“…In cases where varus deformities persist or worsen despite medical management, orthopedic specialists may consider orthotic management or opt for surgical interventions like guided growth or corrective osteotomies [2,6]. There remains no consensus on prioritizing orthotic over surgical treatments, and the effectiveness of orthosis in managing rickets continues to be debated, with studies reporting conflicting outcomes [4,8,13]. Our findings demonstrate that while the initial pharmacological treatment only addressed the coronal tibia bow and medial distal angle (MDA), the introduction of orthotic treatment yielded significant improvements in both coronal and sagittal alignments, as well as rotational adjustments, aligning with previous studies that suggest conventional therapy can improve coronal alignment but may not effectively correct rotational deformities [2,4,6].…”

“…In late childhood and adolescence, when deformities such as severe varus, valgus, or windswept lower leg deformities become more pronounced, treatment often involves surgical interventions [4,14]. Surgical interventions like guided growth surgery offer a less invasive option for correcting coronal plane deformities, allowing patients a quicker return to normal activities [3,4,[6][7][8]10]. However, mostly in cases of severe deformities, such procedures may not provide sufficient correction, necessitating more intensive surgeries involving osteotomies with internal or external fixation [4,6].…”

“…Pediatric hypophosphatemic rickets management aims to control hypophosphatemia, prevent long bone deformities, promote normal growth and minimize bony lesions [3]. Initial treatments often include vitamin D or its analogs and oral phosphate supplementation, though their efficacy varies [2,3,8]. The effectiveness of knee-ankle-foot orthoses in XLH treatment remains a topic of debate [4,8].…”

“…Initial treatments often include vitamin D or its analogs and oral phosphate supplementation, though their efficacy varies [2,3,8]. The effectiveness of knee-ankle-foot orthoses in XLH treatment remains a topic of debate [4,8]. When varus deformity persists or worsens despite medical treatment, surgical interventions are considered, employing guided growth for mild cases and osteotomies with internal fixation for more severe cases unresponsive to guided growth [6].…”