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In physiologic genu varum and congenital tibia vara it is usually bilateral and symmetric, whereas in Blount's disease it may be unilateral or bilateral, and when both tibiae are involved, the degree of affection is often asymmetric.
The metaphyseal-diaphyseal (MD) angle helps with the grading of Blount's disease. The MD angle is obtained by measuring the angle formed between a line drawn parallel to the top of the proximal tibial metaphysis and another line drawn perpendicular to the long axis of the shaft of the tibia.
Blount's disease, or tibia vara, is a growth disorder of the medial aspect of the proximal tibial physis with abrupt medial angulation of the proximal tibia distal to the epiphysis, which leads to varus angulation of the proximal tibia.