When there is vitamin D deficiency over time, the bones lose their rigidity and become distorted making them at risk for fractures. Older children adopted from orphanages often have had fractures due to rickets and the healing of the fracture causes unusually shaped bones. This can be miscontrued as child abuse. Thickening of the wrists and ankles are other early evidences of rickets. Bones of the spine, pelvis, and long bones of the legs can be distorted.
Bow legs can be the result of rickets.
The shape of the head may become box-like due to thickening of the skull bones. Eruption of the baby teeth may be delayed and there may be defects of the enamel and extensive decay of the teeth. Permanent teeth may also inevitably be affected. Muscles are poorly developed and decreased tone is common in rickets. Vitamin D is essential for the absorption of calcium and calcium is necessary for muscle function.