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Rates of Blount disease and childhood obesity have increased in parallel, although the co-management of this acquired comorbidity and obesity is not well described. This report shares the course of a toddler with severe obesity who experienced rapid and persistent weight gain without success from nutrition and behavior changes. After repeat subspeciality evaluation, the patient was ultimately diagnosed with signs of early-onset Blount disease, urging the need for adjunct medical therapy. Initiation of topiramate was shown to achieve weight neutrality and improve the patient's body mass index (BMI), appearing to halt the progression of Blount disease and avoiding escalation to surgical treatment. This report suggests topiramate can be an effective and well-tolerated medication in young patients with a pressing need for weight intervention.

Dysplasia Epiphysealis Hemimelica (DEH) or Trevor's disease is a rare skeletal condition that forms osteochondroma like lesions in the epiphysis of long bones. This occurs mainly in pediatric patients with a predilection for the lower extremities. The knee and the ankle joint are most commonly affected in a hemimelic distribution meaning that either the medial or the lateral part of the center of ossification is affected. We report a rare case of Dysplasia Epiphysealis Hemimelica in an active pediatric patient involving multiple tarsal bones around the left ankle that was surgically excised after using a medial malleolar osteotomy for exposure. At over four years of follow up, our patient is pain free, has no growth arrest and continues to engage in normal activities.