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Hi
I have an 11 year old active boy with years of pain. He first saw me 5 years ago because his mother could get no where with PCP. She finally convinced her to get xyas which confirmed multiple stress fractures (healed). At 2-3 he used to want to be carried because of pain. We put him in orthotics as a last resort and this was a miracle for him! He had more xrays which confirmed Kohlers. Still wearing orthotics . He is now suffering from forefoot pain and Achilles pain. The forefoot pain got so bad he had to stop all activity. He had a cavus foot type which collapses upon weight bearing. Clawing of the toes. Any suggestions as to what could be causing the new symptoms. He loves playing soccer, hockey and basketball. His feet don't hurt playing hockey. I feel I keep missing something. Thanks

 

His feet dont hurt during Hockey.
So the question is what is different when he plays hockey?

Is it the way he moves, soft turf or that he wears a hockey boot?

From what you describe an ankle boot, forefoot rocker or maybe even an Arizona type brace?

 

This is not an uncommon presentation in an active boy. I would suggest the boy probably has Sever's disease and not Achilles tendinitis due to his age. Also telling us he has "forefoot pain" only narrows his pain down to about 23 osseous structures and an equal number of ligamentous, muscular and tendinous structures. In other words, you need to be much more specific with your physical examination findings if you want specific help with this young man.

I would suggest referring the boy to an experienced sports podiatrist or experienced podiatrist who specializes in biomechanics. I'm relatively certain that his pain is 100% mechanical in origin from the little history and physical examination information you provide here.

Natprice, you may want to read the following thread I started seven years ago first before your next posting: Presenting Patients for Clinical Advice

 

Agree. The few patients I've had this age with pain in the tendon itself have been hypermobile (and have usually had Sever's alongside), so may be worth screening for if it is tendon pain.