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Age 7, hot, painful feet during the night, crying in pain

Discussion in 'Pediatrics' started by fancyfeet86, Jun 10, 2013.

  1. fancyfeet86

    fancyfeet86 Member


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    Please help!!

    I am about to see a 7 year old boy, who for over a year has been experiencing 'hot painful feet' which is worse at night. So bad he wakes his parents up with his crying and they have to massage his feet until the pain settles. Their GP referred straight to the hospital and mother could not tell me who they seen because it was 8 months ago but she said it deifintely wasn't a Podiatrist. Whoever they have seen told the parents their son had growing pains and this would disappear.

    The boy was a full term pregnancy and has no other health conditions. According to his mother the pain is only in his feet, he does not complain of heel/knee/calf pain. He has not had any recent growth changes. Pain is worse if he has been out playing.

    Her concern is that it is getting worse, not better. My concern is I haven't a clue what to be thinking about...! Obviously once I actually see the child things may become clearer.

    Can anyone think of anything of the top of their head that I should be thinking about?! I may have Monday brain and something obvious is not coming to me!

    Thanks in advance for any advice :)
     
  2. gavw

    gavw Active Member

    Hope you're settling into the new job OK ;)


    It may well be 'growing pains'. Which is a rubbish name for a pooly defined clinical entity. I would tend to regard 'growing pains' essentially as similar to an overuse syndrome in adults, but presenting in children.

    Things to ask:
    1. Is it worse following days when she has been more physically active? If the parents are motivated ask them to keep a diary to tally up busy days with painful nights.

    2. Do have a look and see if the STJ axis is looking medially deviated. This could, in my experience anyway, make the symptoms worse. I often find a UCBL type orthoses (i.e. deep heel cup, high medial side, maybe even a skive) helps.

    3. Recent growth spurt? Could be causing a missmatch between bone length and their associated soft tissues.

    4. If in any doubt, blood tests might be indicated, but, as they say, common things happen commonly.

    good luck

    Gavin
     
  3. W J Liggins

    W J Liggins Well-Known Member

    Impossible to make any informed comment until you have undertaken a history & physical. What is the nature of the pain, location, duration, onset, aggravating factors (other than weight bearing), predisposing factors etc?

    Please post the results and any pics.

    Good luck

    Bill Liggins
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. harpsy

    harpsy Member

    Possible neuro cause? erythromelalgia, c fibres are over active in warm temperatures , like in bed and cause a relative reduction in circulating oxygen to the tissue , therefore pain and heat follows . Getting out of bed, standing on cool tiles etc seems to help. This cause is out there a little but I would definitely exclude all the usual suspects first.
    I'm not certain what age this syndrome can begin in but I remember when I was about 11 having the same issues , especially if you live in a hot climate, Pain always worst at night. No cure , treat symptomatically. I found wet socks worked well and aspirin 600mg (adults only!). Good luck
     
  6. polyurethane

    polyurethane Member

    Definitely need to consider erythromelalgia. Have a look here:

    http://www.erythromelalgia.org/

    Consider joining http://health.groups.yahoo.com/group/EM/

    I know there are several children with EM represented there. There are several YouTube videos as well which might help.

    Does elevation of the feet help?

    Treatment is very difficult with highly idiosyncratic responses and changes over time.

    You might find the document here useful in thinking of the various possibilities:

    http://www.racgp.org.au/afp/200312/20031218makkar.pdf

    Rod

    [Added] Most likely specialists are dermatologists (often diagnose, useless for treatment), neurologist or rheumatologist. But pretty much none of them know as much as experienced patients.
     
    Last edited: Jun 16, 2013
  7. carolethecatlover

    carolethecatlover Active Member

    The naturopathic response is lots of vitamin B. It has worked for me in the only case I came across. A mature male.
    I haven't got my Vitamin guide at hand, but I think it was 2 x Mega B for 14 days, and I think it was B6 in particular.
    It was an almost instant cure for lots of other non-foot related problems, chapped lips, brittle hair, hair fall out, itchiness.
    Can I suggest a tablet of magnesium too?
    If it is growing pain, the mineral you are most likely to be short of in the modern diet is magnesium.
     
  8. Bug

    Bug Well-Known Member

    I'm sorry carolethecatlover but I disagree. There is not enough evidence that supplementation will assist pain in children, even with growing pains.

    I would hesitantly suggest that magnesium be of use in hot sweaty kids that get calf cramps at night but that would be about it and only after a very very thorough assessment.

    Gavw, I would encourage the parent to see a paediatrician or Rheumatologist. I think there needs to be a thorough systemic assessment with a priority of blood tests. I'
     
  9. polyurethane

    polyurethane Member

    Someone very close to me suffers from Erythromelalgia. So, if it happens to be that, then...

    Any more than very ordinary, small doses of B6 cause her extremely unpleasant dreams. And it does not seem to help at all.

    B12 (at least, as methylcobalamin) might help her a little bit.

    Magnesium might help a her little bit - sometimes. (She finds a simple, short, foot soak in water with Epsom salts can help in both cooling and absorbing magnesium. However, soaking in any other sense, such as for longer or in water without anything added, is to be avoided.)

    If someone has "brittle hair, hair fall out, itchiness", then thyroid disorders would be high up on my list of possibilities to be considered.
     
  10. carolethecatlover

    carolethecatlover Active Member

    As I said, only one patient, and a mature male. But the B vits produced fast, within a week and remarkable remission, of pain, burning and itchiness and dry patches.
    I talked the case over with a friend studying naturopathy, and it was her suggestion. I am suprised that B6 gives unpleasant dreams. If I get another case, I will suggest it again.
    I take Bvits when I remember, and I have better hair and much better skin than previously.
    It is believed by Naturopaths, that modern diets are really, really deficient in all the B vitamins. But thanks for the previso. I will remember it.
    Itchiness is more likely to be immune response producing histamine. I am actually studying this as part of my study into dyshidrosis.
    Magnesium is given much more freely by Vets for better bones in animals. But I agree, super supplement for calf pains.

    Do you think we can get some kind of follow up and find out what is causing this kid to suffer?
    I really would like to know.
     
  11. polyurethane

    polyurethane Member

    Enhancement of dreams is a well-known effect of B6 - sometimes good, sometimes bad. Try a search of "b6 dreams" and you will see lots of hits.

    Increased sensitivity to all manner of things (whether eaten or simply exposed to) is a very commonly reported issue in those suffering hypothyroidism. Sometimes when untreated, sometimes when starting treatment. Indeed, very unfortunately, sometimes it carries on despite what would otherwise appear to be optimal treatment. Some level of proof that it is a histamine issue comes from trying ordinary anti-histamines which will reliably reduce the symptoms. Partner has to do that every time she eats any fish, for example.

    Partner's use of magnesium is in a desperate attempt to reduce the pain of the burning feet - not a calf issue.

    Oh, and partner also seems unable to tolerate B7 Biotin in anything more than the amount in her diet.

    I agree - it would be very interesting to read a response from the OP.
     
  12. polyurethane

    polyurethane Member

    Silly me, only jut noticed that OP is in Scotland.

    If Erythromelalgia is in the frame, then you might wish to get the poor lad to the attention of:

    Professor Jill J F Belch
    Professor of Vascular Medicine and Tayside R&D Director

    Division of Cardiovascular and Diabetes Medicine
    Medical Research Institute
    Mailbox 1,
    Ninewells Hospital
    Dundee DD1 9SY

    One of the few medics who does have experience of EM.
     
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