Help with diagnosis...

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Patient is a healthy active 4 year old male. Patient is waking up with moderate to severe pain in the tops of both feet at least once a week. The severity of the pain has gradually increased since the onset of symptoms. Symptoms appeared approximately two years ago. When walking the patient does not present with any issues. Xrays and blood work came back normal.
Symptoms appear to be better when patient is swimming on a daily basis.

 

Hi,

I would be interested to see other people's responses.

I find that this is very common (I see a lot of children). Xrays and bloods and negative and the rheumatology team find no concerns either.

You can't class them as growing pains as they are happening in a joint area (and the foot which is exempt in the classification).

I can only assume it has something to do with bone turnover, which is typically more effective at night, as with Pagets.

With these cases I tend to advise them to keep a pain diary, highlight red flags/ what to look out for, calf stretches, trainers, ask them to try a fleixble sole then a rigid one and finally I try a 'neutral' insole - which can help.