Nocturnal toe pain

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Hi
10 year old patient presented today with pain starting at the base of his hallux nail. Duration 5 years (started age 6), wakes him up during night eased by dad massaging. Pain can radiate up anterior shin. Not associated with increased activity, started with pain only at rest but can occur now during the day.

Child has general good health, xray NAD. Dynamic examination indicated early heel lift with adctuctory twist and apropulsive. static examination = functional hallux limitus. good strength in flexor & extensor hall long. No pain on examination of MtPJ's, no crepitus.

Any ideas??????????

 

:welcome: Heidi

I think you might get a better response to your case presentation if you have a look at this thread. The more information you can give and the less ambiguous the information, the better the value of the suggestions you might have back

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=22144

That being said, any nocturnal pain makes me think of neurolgical pain. Have you done a neuro examination?

If the pain is with the ankle plantarflexed, the structures under tension might be the deep peroneal and medial dorsal cutaneous nerves

Good luck

Robin

 

Dear All
Night pain is a red flag and in children a very big red flag.

One thing that is possible is a glomus tumour. I know it is rare but can present as night pain and nothing else. As the tumour grows it then causes pain throughouit the day.

This child needs a paediatric rheumatologist or to be referred to a childrens hospital for senior staff to check over.
Lovely day still in Fremantle WA
Regards
musmed
Paul Conneely

 

Less frightening but sometimes harder to track down is a posture distortion which causes a repetitive stress on the hallux.
My mapping of these reflexes would indicate a possible head position. http://reflexposturology.weebly.com/
It could be a sub occipital, atlas, axis problem.
Holding a steady palpation of the fore foot and ankle while the child does active posture changes may allow you to feel what triggers the excessive reflex pressure on the hallux.