Brace treatment of early infantile tibia vara

We reviewed 24 children (42 extremities) who had a diagnosis of early infantile tibia vara treated by using a brace. The indication for bracing was either a varus deformity that was not improving by age 18-24 months, or a persistent varus deformity seen in a patient older than 24 months. We prescribed an above-the-knee brace with a free ankle, single medial upright with valgus-producing straps, and either no hinged joint or a locked hinge joint at the knee. The braces were worn during the day and were removed for bedtime. The patients were followed up for an average of 27.2 months (range, 12-72) from the initiation of brace treatment, and the outcome at latest follow-up was determined by using radiographic criteria. Before treatment, 29 extremities were Langenskiöld stage I, II were stage II, and two were stage III. Before treatment, the metaphyseal-diaphyseal angle averaged 16.4 degrees. Forty of the 42 extremities had metaphyseal-diaphyseal angles of > 11 degrees, and 20 were > 16 degrees. Based on our criteria, we rated 29 extremities good, nine fair, and four poor. We conclude that daytime, ambulatory brace treatment may favorably alter the natural history of tibia vara in patients who are younger than 3 years and who have Langenskiöld stage I or II deformity.