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Burning Feet in 2 Year Old Child

Discussion in 'Pediatrics' started by Louise Wilson, Sep 24, 2009.

  1. Louise Wilson

    Louise Wilson Member


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    Hello,

    I am wondering if anyone can give me any advice on a patient I have.

    She is a 2 year old who is complaining of burning pain in both feet. This only occurs at night and only subsides when her parents sit on the bed and rub her feet. Mum says patient becomes very distressed and screams.

    On examination biomechanics is normal and there is no other medical Hx. When I saw the patient her feet were burning to touch.

    Blood tests have came back normal.

    I have urgently referred the patient to Yorkhill Sick Kids Hospital in Glasgow. I am thinking that this could either be pyschological or neurological?

    The mum of the wee girl keeps phoning me and I'm not too sure what else I can say to reassure her.

    Any advice would be much appreciated.
    Cheers

    Louise
    :bang:
     
  2. ladyfaye

    ladyfaye Active Member

    Hi Louise

    The poor lass.It must be so uncomforatble for her.Considering the age I have to agree wth you-its probably neurological or Psychological (??);not sure about the psychological though unless theres something else to suggest that.You say that the childs feet were burning to touch? My feeling that this may be perhaps physiological or even psychosomatic?

    I would be very intersted to find out what the wee patient is suffering from.Good luck in your quest to find out.

    Regards

    Faye
     
  3. mgates01

    mgates01 Active Member

    Hi Louise,
    the most obvious things that come to mind regarding burning feet are either neurological, infection, or dermatological. i'd be wanting to know,
    How long has she had the problem?
    Has there been any change of footwear recently?
    You said the girls feet were "burning to the touch". Where they red / inflammed ?
    Was she complaining of pain in the clinic that day when you examined her?
    Is pain relief ever administered by the parent?
    Does the pain wake her up?
    Is there a pattern to the pain (does it occur every night / what time, etc)?
    Is the heat primarily on any part of the foot (dorsum, sole, up leg)?

    I'm assuming you're thinking psychological because the pain is only at night and there are no obvious reasons for this. Psychologically it could be a learned response to get attention or alternatively a response to a change in the girl's social surroundings (e.g started nursery, arrival of a new baby, mum returning to work etc). Determining if pain is psychological can be tricky and can often upset parents who think you are accusing their child of faking. I always suggest that if the child is complaining of foot pain, and the parents normal response is to massage the affected area, then change this pattern by rubbing the hand or the cheek and see if this alleviates the pain. I have had a few cases like this and it someytimes takes a couple of visiyts to get to the bottom of this.
    I have to say though if you have identified the child's foot as "burning" then this makes the psychological resonse less likely. Just a thought - maybe you should try and quantify the temperature, to ensure you're not mistaking the hot feet of a child who has been rushing ariound with mum all morning before arriving at your clinic.

    Hope of this helps

    Michael
     
  4. cornmerchant

    cornmerchant Well-Known Member

    Louise
    You are right to refer the child to a specialist hospital. This problem is completely out of our remit.

    Cornmerchant
     
  5. robert bijak

    robert bijak Banned

    consider causalgia, reflex sympathetic dystrophy, sympathetic interference like cauda equina or other spinal masses, vitamin b or c deficiency, diabetes, polycythemia. How are the reflexes and sensation tests? How are the x rays? What's the race of this patient ? Sickle? Any osteoporosis to indicate hyperemia, really ck for spina bifida(occult). lastly consider contact eczema and way out there, Porphyria. robert bijak dpm
     
  6. Louise Wilson

    Louise Wilson Member

    Thankyou all for your words of wisdom.

    Micheal, with regards to questions to ask during Hx, This has been going on for a few months now, no change of footwear, the feet are not red or inflammed, when I examined her she was not c/o pain and said it was only at night time, the pain wakes her up every night around 2/3am and is on the plantar aspect of both feet. So far through tests we have managed to rule Diabetes out.

    I shall keep you updated on the progress of this case.

    Louise
     
  7. Sally Smillie

    Sally Smillie Active Member

    My first thought reading this thread is the fact that a 2yo is unable to describe "burning pain". That means that that description has come from an adult or someone else. It may send you barking up the wrong tree. With a child this small, you need to just look at the eveidence as you can't depend on patient history.

    It is not at all unsual for children to wake crying at night wanting their legs rubbed -in a general pattern and not focal. This pattern in feet however, I have not seen. The leg one is very typical of hypermobile youngsters and is a primary symptom of fatigue due to muscle overuse in compensation for excess joint movement and musculature to stabilise.
     
  8. mgates01

    mgates01 Active Member

    Hi Louise,
    I would agree with Sally and the fact that this child is only 2 would make me presume that the bulk of the information / history you are getting is from mum.
    What is puzzling as well is that the foot pain / burning doesn't seem to appear until night time. As Sally said nocturnal leg pain is relatively common and to a certain extent one can usually work out a potential reason for why it might be occurring.
    I have had a few parents presenting with children with foot pain that only occurs at night.
    These children almost universally never present in the clinic with pain.

    I'm not meaning to pre-judge this case but an experience I had with the very first child I ever saw who presented with similar type of symptoms, (she had severe pain on the top of her foot and woke screaming - usually about an hour after being put to bed), might help. These symptoms where only relieved by the mum rubbing her foot.
    After tearing my hair out I asked the mum to change her response to the child's pain. I asked her not to rub her foot but to sit and hold her hand and try and calm her in another way. I suggested that the child might be waking soon after being put to bed, might be becoming a little anxious and that this was the child's way of getting mum to come and spend a bit more time with her.
    To cut a long story short this startegy seemed to work and mum confided that her and her partner had recently seperated (he had been quite involved in the child's life up to that point), and the mum now believed that the foot pain was the child's response to this change in her life that she couldn't quite understand.
    This may or may not have been the reason, but the foot pain disappeared when the reponse to it changed.

    As I mentioned earlier in a previous post sometimes small changes to a childs routine can produce anxiety which can then feed off the anxiety of the parents. The child effectively produces a Pavlovian response in the parent that becomes self perpetuating unless somehow you can break that cycle.

    I'm not saying this is the case with your patient but after my experience I often treat these puzzling foot pains with a more thorough history of any changes that may be occurring within the family unit.

    Good luck and I would be really interested to see how this all works out.

    Michael
     
  9. Tree Harris

    Tree Harris Active Member

    Hi there everyone,

    After reading through the posts, I also thought that one should consider the response pattern that the parents are establishing. Super Nanny might be of benefit in this instance. Does Super Podiatrist exist? Heres hoping.
     
  10. Louise Wilson

    Louise Wilson Member

    Hi all,

    A wee update, Since I referred the patient to Yorkhill Hospital in Glasgow, she is now being tested for Rhuematoid factor, that's all the information I've been able to get my paws on so far, but Tree Harris, I completely agree with the Super Nanny suggestion, and Super Pod!
     
  11. TracyLee103

    TracyLee103 Welcome New Poster

    I'm curious to find out if there was an update to this thread?
    My son had the same symptoms when he was younger. Burning feet at night.
    It would wake him up from a sound sleep.
    His feet were literally hot to the touch.
    The only thing that would help was to stand on cold tile or soak his feet in cold water. He was falling asleep standing on the bathroom tile. He was clever enough to start sleeping with a big gel ice pack at the foot of his bed.
    (like the ones you put in lunch boxes.. but not the same one.. I hope)
    Doctors tested him for diabetic symptoms, negative.
    He had EXCELLENT circulation (as one podiatrist pointed out, my kid had very hairy legs even at nine)
    It was not a cry for attention, it was very annoying to him to be woke up.
    His feet were literally hot to the touch, we were both very puzzled.
    Thank goodness he eventually grew out of it, and it occurred less and less.
    I was curious to find out what the cause may have been just in case any future young members of our family develop the same issue.
    Thank you .
     
  12. LaurenJ

    LaurenJ Welcome New Poster

    I see this is an old post, but I too would be interested in an update. My 3 year old son complains also of "tickling feet" which are very hot to touch. The sensation is very irritating for him and occurs during the day but also at night. It wakes him from sleep also and he requests a cold compress to alleviate the discomfort.
    We have had bloods done which returned normal and a pediatrician suggested something similar to restless leg syndrome which myself and my husband suffer from( as do grandparents from either side)
    This has gone on since he could communicate the feeling at around 20 months old. I worry there may be some underlying issue but have always come up blank. Any response would be greatly appreciated.
     
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