Rickets: A disease of the past or a resurgent cause of waddl
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Rickets as a cause of bone pain and lower limb deformity is now commonly thought to be a disease of the past. However, in the last few years, there has been a resurgence of cases.

Case Report
A two-year-old Asian girl presented to a pediatric orthopedic clinic with an immature, hesitant gait. She first walked unaided at 11 months but was unable to run or hop. She was otherwise fit and well and there was no significant past medical, social or family history. She had a healthy diet and was fed both breast and cow's milk, yogurt and also Indian food including rice and lentils. Physical examination revealed internal tibial torsion and tibia vara with palpable bony swellings over the distal anterior tibial metaphyses and distal radii.

Investigations
Tibia/fibula radiography demonstrated widespread metaphyseal cupping and splaying of the epiphyses Laboratory evaluation confirmed nutritional rickets.

Differential Diagnosis
Congenital and developmental bowing
Blount disease
Neurofibromatosis
Skeletal dysplasia

Treatment
Treatment with ergocalciferol and calcium supplementation was commenced.

Outcome and Follow-Up
The child's vitamin D level normalized after seven months and she returned to normal mobilization. She was commenced on prophylactic vitamin D and discharged from specialist care...

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