Rickets

Rickets is a disorder of the growing skeleton in which bone fails to mineralise properly, most often from vitamin D deficiency, sometimes from dietary calcium deficiency or an inherited phosphate disorder. The bone becomes soft and deforms under load.

The primary treatment is medical

Correcting the underlying deficiency is the treatment, and it is a paediatrician's job — vitamin D and calcium supplementation, or specific management for inherited forms. Physiotherapy does not correct rickets, and any deformity will continue while the deficiency persists.

Vitamin D deficiency remains common in India despite abundant sunshine, largely because of limited sun exposure, skin covering, air pollution and dietary factors.

What it looks like

Bowing of the legs or knock knees once a child starts weight-bearing, delayed walking, muscle weakness, bone pain, widening at the wrists and ankles, and delayed tooth eruption. In infants there may be softening of the skull bones and a delayed fontanelle closure.

Where physiotherapy contributes

• Strengthening weak muscle, which is a genuine feature of the condition rather than just disuse
• Supporting delayed motor milestones — sitting, crawling, standing, walking
• Gait training as the legs remodel
• Advice on appropriate activity — protecting soft bone from excessive loading while not immobilising a child who needs to move
• Working with orthotics or orthopaedics where bracing or surgery is being considered for significant deformity

What to expect

With medical treatment, bone chemistry improves within weeks and bone changes over months. Mild to moderate bowing frequently corrects on its own as the child grows and the bone remineralises. Significant deformity that persists may need orthopaedic input.