Trilogy of Covid-19 pandemic inactivity, Vitamin D deficiency and Genu Valgus knee deformation: Indolent manifestation of concern in preadolescents

The Covid-19 pandemic has affected the health in myriad ways. The direct affection may lead to respiratory infection. An indirect effect of Covid-19 has manifestations on the physical, mental and behavioural attributes in majority of the age groups. The forced restrictions, limited activities, and changed lifestyle have aggravated the deleterious effects of the sedentary lifestyles. The management of the physical activity for all age groups especially pre-adolescents took a relative back-seat during the Covid-19 restrictions with no immediate suggestions for an active treatment protocol strategy. The clinicians in general, emphasised on the conservative measures to manage the increased incidence of vitamin deficiency and osteopenia majorly with consultations based on telecommunication without clinical evaluation. The subsequent delayed assessment showed a profound negative impact amongst the pre-adolescents with significant progression of knee deformation and increased outpatient clinic presentation of genu valgus for management in later phase of pandemic. This has posed a unique Covid-19 post-pandemic manifestation of concern.The trilogy of Covid-19 restrictions induced poor physical activity, vitamin-D deficiency, and deformation of knees to valgus angulation have crippling effect in the pre-adolescent age-group. The delay in timely identification and medical management for the pre-adolescents has aggravated the joint deformation compromising the functional outcomes. The orthopaedic surgeons are now challenged and burdened to manage pre-adolescents knee deformity for corrective medical and surgical measures. On literature review, the guidelines are sparse for the paediatric orthopaedic management. The silent worsening with increased morbidity presents a matter of substantial concerns.An individualized management strategy for pre-adolescents is strongly recommended to manage this “silent” morbidity.