Podopaediatrics - bony bump

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Dear colleagues this is my first thread here after couple of years. I have been very sceptical on a case I had seen yesterday at my clinic. A mother brought her 5 year old girl to clinic complaining of pain on the proximal aspect of the foot due to some new bumps which have appeared since the beginning of summer. The child is complaining of pain on those areas (only when using shoes) and refuses to wear her trainers at school and returns home wanting to wear her flat shoes or flip flops. The areas of pain were palpated and I could quite easily feel the firm and not moveable bump equally on both feet and on the same point (which was the medial cuneiform if my surface anatomy is as good as it used to be). Furthermore the examination has shown joint hypermobility of the ankle , elbow and thumb and as a note the girl is a ballet dancer for the last two years. Other than appropriate footwear with extra depth would you advise for orthotic insoles, any further diagnostic examinations ? Also don't you believe ballet will continue to trigger this area ?

 

Any imaging?

 

William I have been the first person the parents visited for this problem so we have no imaging results. The child is young and this developed on both sides and I am unsure if I should be asking for an x-ray.

 

possible kohler's

 

1st stop X-ray, otherwise you're just guessing.

 

Thank you for the replies timharmey and W J Liggins.