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Four year old boy with "sensitive" feet.

Discussion in 'Pediatrics' started by DaveJames, Mar 27, 2012.

  1. DaveJames

    DaveJames Active Member

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    Hi All,

    Just wondering if anyone can help with this patient I had in clinic today.

    Four year old boy, no issues with developmental milestones, walking at 9 months.

    PC - painful and sensitive feet
    HPC - his mother reports that about 3 weeks ago he started to complain about his feet being painful and refusing to wear shoes of any kind. She has bought him flip flops which he asks to wear all the time.
    No medications, surgical history, medical history or allergies
    Socially - no issues

    On examination:
    Pulses - palpable and regular
    Neurological - 10g felt at all tested sites
    Nails - no issues or cryptosis
    Skin - no lesions or rashes
    Bio - no obvious concerns - good range of motion and within expected limits
    Footwear - clarks shoes today, well fitting and with socks

    I've quizzed his mother about changes which may have occurred recently; she reports no changes to washing powder or soap products. When I mentioned diet there was a small pause and she said he was on multivitamins which ran out around 5 weeks ago.

    My thoughts are that it could either be a supplement deficiency or a simple childhood "thing". I've advised mom to look at his diet and to continue with monitoring his footwear use and see if a pattern emerges. Other than that, I've reassured mom with the other findings.

    Does anyone have any pearls of wisdom or experience they could share.

    Thanks for reading and I await any assistance you can offer.

    Kind regards,

  2. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    Hi there, I am a podiatrist with thirty years experience , and a mother of three sons, now grown.
    This is an attention seeking matter. The mum needs to spend a bit of time rubbing in cream (anything) and chatting with her boy. Give hima choice with new shoes. All will be well in a couple of weeks I promise. Good luck
  3. RobinP

    RobinP Well-Known Member

    Hi Dave,

    I'd be inclined to agree with Elizabeth but it is not outwith the bounds of possibility that magnesium or Vit B12 deficiency could be a factor although unlikely.

    The only other thing that I have come across in cases like this is sensory integration disorder(called something else now but I can't remember it). Given, however, that the symptoms only started 3 weeks ago and the child does not appear to have ADHD or other developmental issues, again it is unlikely but a potential DDx

    Good luck
  4. Tkemp

    Tkemp Active Member

    See if anyone in his class at school wears flip-flops/ thongs.
    It may be jealousy and a way of ensuring he also wears them :rolleyes:
  5. Tkemp

    Tkemp Active Member

    Although, it may be due to thiamine deficiency - though this is usually seen in alcoholics.
    This can lead to skin sensitivity.
    If he eats very processed grains, eg white breads, and drinks tea/coffee (some parents allow their children to start young), and doesnt eat eggs or leafy green vegetables, then it may be possible.
    Check if his teeth and gums are also sensitive.
    If so then he may need blood tests and referral to a Dietician.
    However, as first mentioned, this is rare in children but is worth considering.
  6. DaveJames

    DaveJames Active Member

    Hi All,

    Thanks for your replies and apologies for my delayed response. The information you've given me is really useful and lots to consider.

    My plan is to review the patient over the next couple of weeks to see how things are generally and then I will report back.

    Kind regards,

  7. dragon_v723

    dragon_v723 Active Member

    Nice responses everyone I learnt a bit as well
  8. toughspiders

    toughspiders Active Member

    Hi there,

    Some children have sensory issues especially gifted, aspergers or ADHD children. In the absence of illness I would refer to a occupational therapist who specialises in children. Also worth asking if other sensory issues are present.
    For example
    Annoyance with clothes, their labels or textures
    Cover ears with hands at loud noise
    Doesn't like being hugged etc

    There are loads of variations on this. a child maybe interpret display these dislikes iin a way we wouldn't necessarily understand.

    Only know this because I did a lot of research , I also own one of these children

    The ot's are really good at dealing with these kids
  9. DaveJames

    DaveJames Active Member

    Thanks for your feedback TS. I'm still waiting to review this child; however, the mom hasn't contacted me with any problems.

    Kind regards.

  10. Bug

    Bug Well-Known Member

    I think there is a lot of useful info here but am also inclined to agree with Elizabeth.

    Kids with sensory issues or sensory processing disorder don't grow into it or out of it. They always have it and can often show issues with footwear and clothing from a very young age. As they get older, they are able to verbalise it more. SPD affects how kids interact with the world and is rarely isolated to just one thing ie: Tactile or touch. It often goes hand in hand with auditory, vestibular, oral, visual etc.

    If you are interested in learning more about SPD, this is a great website to learn more from: http://www.spdaustralia.com.au/about-sensory-processing-disorder/

    As an aside though, I'd do some general neuro tests to make sure all is OK.
  11. davidh

    davidh Podiatry Arena Veteran

    You may be right, but personally I wouldn't be rushing to diagnose anything over the net.

    OP - did you check to see if there was a familial history of RA or other rheumatological disease? outside chance, but a possibility.
  12. DaveJames

    DaveJames Active Member

    Bug and Davidh - thanks for your input.

    David, in answer to your question, there was no report of RA or other rheumatological family history.

    Kind regards,


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