Incidence and Risk Factors of Rachitic Genu Varus in Preschool Children in a Paediatric Health Institute in Egypt as One of the Developing Countries.

BACKGROUND: Rachitic genu varus is one of the common conditions among the Egyptian children, despite the shinning sun of Egypt all the year. PURPOSE: The aim of the study was to estimate the incidence of rachitic genu varus among the Egyptian children, and to assess the risk factors contributing to it. PATIENTS AND METHODS: This prospective study recruited a total of 250 consecutive children, being 130 males and 120 females, with rachitic bow legs or genu varus, between 2 - 4 years of age, together with 250 controls of the same age group, out of a total number of 1900 children with other types of rickets, and other children's orthopaedic diseases, who presented to the National Institute of Neuromotor System in Egypt between September 2014 to September 2015. The cases and the controls were subjected to clinical, laboratory biochemical, and plain radiographic examinations. Their parents were subjected to epidemiological, maternal, and nutritional questionnaires. RESULTS: The calculations revealed high incidence (13.1%) of rachitic genu varus. The risk factors were low socioeconomic status, insufficient family income, poor housing conditions, lack of exposure to sunlight due to cultural practices, sole breast feeding, and inadequate supplementation of vitamin D to the children and the pregnant women. The p value was <0.05. CONCLUSION: Vitamin D deficiency rachitic genu varus is a multifactorial condition in Egypt. Raising the standard of living, level of education, housings, and dietary supplementation of vitamin D to the pregnant women and infants are the solution.

Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy.

BACKGROUND: Hallux valgus deformity is a common sequel of spastic cerebral palsy. METHODS: Twenty ambulatory patients (24 feet) suffering hallux valgus deformity, with painful forefoot and restricted footwear, secondary to spastic cerebral palsy acquired perinatally, were treated with great toe metatarsophalangeal (MTP) arthrodesis using percutaneous K-wires for fixation. The mean age at the time of surgery was 16.2 years (range 14-18 years). They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3 years and 4 months (range 3-4 years) by physical examination and radiographs. RESULTS: All patients had a stable painless aligned great toe, with <10 degrees valgus, <20 degrees dorsiflexion and neutral rotation after arthrodesis, evidenced by improvement in pain, cosmesis, functional activity, footwear, callosities and hygiene, as well as by significant improvement in the measures of the MTP and the intermetatarsal angles (IMA) by postoperative radiographs. Neither non-union (pseudoarthrosis) nor recurrence of the deformity developed. Complications included superficial wound slough in a single case. Using the modified American Orthopaedic Foot Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, 18 feet (75%) were classified as excellent and six feet (25%) as good. Neither fair nor poor cases were recorded. CONCLUSION: Hallux valgus deformity in adolescents with spastic cerebral palsy is best treated by great toe MTP arthrodesis to improve segmental foot malalignment and dynamic foot deviation.