Deformity of the head appears very early in the dis-ease and is due to the thickening of the cranial bones, producing the typical square head of rickets. This square head is known as caput quadratum. Numerous soft spots are formed in the cranial bones which when pressed upon give one the impression that he is feeling parchment. This is known as cranial tabies. The fontanels and sutures are very late in closing, sometimes as late as the third or fourth year. The large rachitic head must not be mistaken for hydrocephalus.
Deformities of the Thorax
The chest is deformed in such a way that the transverse diameter is decreased and the antero-posterior diameter is increased. This produces the typical pigeon breast. Such deformity is caused from the softening of the thoracic bones. Beading of the ribs is characteristic and is known as the rachitic rosary. These nodules are formed at the junction line of the costal cartilages and the ribs. While these nodules are always present, they are not always visible. The rachitic gurgle, which is a transverse depression extending from one side of the chest to the other and is about two inches broad, is also present.
Deformities of the Spine
The most characteristic deformity of the spine in rickets is a kyphosis usually involving the lower dorsal and the entire lumbar region, although lateral curvatures may appear. In a well defined case of rickets every bone in the body may be abnormally involved. The deformity of the spine results from a softening of the bones which give way under the weight of the trunk.
Deformities of the Extremities
A case of rickets usually presents characteristic curvatures of the bones. The long bones are, as a rule, involved symmetrically. Green stick fractures very often occur. In practically all cases of this dis-ease there is an arrested longitudinal growth in the bones. Because of this the height will often be very much less than that of the normal child. There is marked enlargement of the epiphyses at the wrists and ankles. The slight curvatures in the bones of the arms will be exaggerated when the child begins to creep and the curvatures in the legs will be increased when the child begins to stand and walk.
Deformities of the Abdomen
Due to the general motor minus condition of the abdominal muscles there is developed a condition known as pot belly. This enlargement is often exaggerated by intestinal indigestion and constipation. This constipation results from the motor minus condition which interferes with the vermicular movement of the intestinal tract.