To think they should have Xrayed

[Starlight86]

DD age 6 had an accident on the trampoline in gymnastics on Tuesday.

She hasn't been able to weight bare properly since then, only able to limp on her toes. The pain is specifically her heel.

The pain has got worse and today she was crying, so her dad took her off to A&E for an x-ray ....... her foot has swollen but not extreme, enough though that the nurse commented on it.

Anyways a doctor came and looked at it, said she wont have broken anything as to break a heel you need to fall from a height and said probably a sprain and sent her on her way.

Husband did try to say about an xray but they said no need...

Also just to add - our minor injury unit does not xray children.

@Starlight86

From what i gather,

She was on the trampoline, she was jumping and someone else came on and jumped so it made it like a double jump if that makes sense....so when she landed the trampoline was springing back up from someone that had already jumped therefor it wasnt as springy.

Does that make sense lol

Christ, that's really dangerous. Any trampolines I've seen always have signs saying not to do that. If that was at a supervised gymnastics class and allowed to happen I'd be very upset.

@Starlight86

From what i gather,

She was on the trampoline, she was jumping and someone else came on and jumped so it made it like a double jump if that makes sense....so when she landed the trampoline was springing back up from someone that had already jumped therefor it wasnt as springy.

Does that make sense lol

The mechanism of injury isn't really key at this point. Sometimes apparently trivial injuries can cause fractures. I suspect the A&E doctor who told your DH that "It can't be broken because it wasn't a significant fall" hasn't been an A&E doctor for very long!

The key points at this stage are that your DD is still non-weight bearing and that the pain is worse. It's also significant that she was non-weight bearing from the outset. She needs an x-ray. Even if it isn't broken she may benefit from immobilisation (splint/cast) but this is only true of some soft tissue injuries and can make others worse, so please get her seen in A&E again, don;t just immobilise to see what happens.

@shouldistop yes, coach was there, believe it happened very fast before other child could be taken off, they are all around age 6 so just little kids not realizing

Could be a sprain, could be a fracture... If it were me I'd prefer an x-ray, but exposure to radiations should be minimised, so, tough call...

You can try and get a second opinion, or do a bit of "watchful waiting" first. If your DD is coping well, treating it as a sprain (for now) may be enough, but if she's not coping and/or symptoms worsen, go and get her seen again ASAP.

Instead of popping straight back to A&E, you may try to get an emergency appointment with her GP. They can't do x-ray, but they can advise, if you're not sure (and maybe direct you to services who can help. I was surprised a few months ago that my GP could arrange ultrasound scans without going through our local hospital!)

@MissLucyEyelesbarrow

She did go ask someone although im not sure who, also totally forgot about this and not to drip feed but last year she was diagnosed with kohler's disease on that same foot (all better and healed now)

So when my husband said he wanted an xray for her due to the fact also she had kohlers in that foot and dealt with that pain for 4 days before we took her.

However the doctor said the fall wasnt hard enough to warrant an x-ray and she wont have fractured her heel and due to the fact that the pain is all in the heel means shes just sprained it.

Advised no gymnastics for 2 weeks but also advised still to walk and run on it.....

@RobotValkyrie

Could be a sprain, could be a fracture... If it were me I'd prefer an x-ray, but exposure to radiations should be minimised, so, tough call...

You can try and get a second opinion, or do a bit of "watchful waiting" first. If your DD is coping well, treating it as a sprain (for now) may be enough, but if she's not coping and/or symptoms worsen, go and get her seen again ASAP.

Instead of popping straight back to A&E, you may try to get an emergency appointment with her GP. They can't do x-ray, but they can advise, if you're not sure (and maybe direct you to services who can help. I was surprised a few months ago that my GP could arrange ultrasound scans without going through our local hospital!)

Speaking as both a GP and A&E doctor, it is a complete waste of time going to a GP at the stage. We don't have x-ray vision. I'm extremely experienced in assessing musculoskeletal injuries, because of my A&E work, but there is nothing useful I could do in general practice at this stage.

Watchful waiting may have been appropriate on Day 1, but this child is now nearly 72h from the injury and still non-weight bearing. That is a concern, and she needs a fracture excluded. She also needs assessment of the whole leg, not just the heel, if this hasn't already happened, because it's not unusual for a young child to describe the pain as being in a different site to the actual injury.

It's still most likely that this is a soft tissue injury. But the only way to be sure is an x-ray and, at this stage, that is what should happen.

Its terrible but i feel like if i went back and demanded an xray i would die of embarrassment if it was nothing, but then equally if i dont and there is something wrong ive potentially damaged her for life and her gymnastics sport which she loves and is on a competitive pathway for.

the doctor said the fall wasnt hard enough to warrant an x-ray and she wont have fractured her heel and due to the fact that the pain is all in the heel means she's just sprained it

I would agree that is unlikely that she has fractured the main body of the calcaneous (heel) though - as I said above - you can never say never in medicine! I don't like getting into guessing diagnoses on the internet, when I haven't seen the patient, but there are a number of other fracture-dislocations of the foot and ankle that should be excluded, particularly a talar fracture. They aren't common in children, but forced dorsi-flexion (the foot being pushed back towards the ankle) is the classic mechanism of injury, and - from your description - may well be what happened to your DD. She could also have a dislocation without a fracture.

@MissLucyEyelesbarrow

the doctor said the fall wasnt hard enough to warrant an x-ray and she wont have fractured her heel and due to the fact that the pain is all in the heel means she's just sprained it

I would agree that is unlikely that she has fractured the main body of the calcaneous (heel) though - as I said above - you can never say never in medicine! I don't like getting into guessing diagnoses on the internet, when I haven't seen the patient, but there are a number of other fracture-dislocations of the foot and ankle that should be excluded, particularly a talar fracture. They aren't common in children, but forced dorsi-flexion (the foot being pushed back towards the ankle) is the classic mechanism of injury, and - from your description - may well be what happened to your DD. She could also have a dislocation without a fracture.

Thank you for all your imput.

Im going to asses over the weekend and if i see no improvement at all ill be taking her back for an xray.

I twisted my ankle a while ago while out walking the dog.

I couldn't stand on it at all, and had to phone dh to collect.
Sat at home with bag of frozen peas and it was so painful. Couldn't weight bear at all, swollen and agony to the touch.

So dh took me to A&E. Due to Covid, he had to drop me off, and then I discovered we needed to be at a different door, and had to hobble 20 yards to the other door. Took me ages, and arrived at the other door, literally crying in pain, and trying to be adult and keep it all together.

Got x-rayed and it was not broken.

I couldn't walk for 2 weeks, and after that, only hobble. Didn't drive for about a month. Pain was awful. Swelling was huge, and when the bruising came out my whole foot was purple.

I know ankles and heels are different, but I am just saying that soft tissue injury can be awful

I'm surprised they didn't
I went to a&e with a painful foot/ankle, no trauma, no swelling or bruising. They said it wouldn't be broken but would x ray anyway
Multiple breaks to my foot and ankle, and I was totally mobile on it

@Starlight86

Its terrible but i feel like if i went back and demanded an xray i would die of embarrassment if it was nothing, but then equally if i dont and there is something wrong ive potentially damaged her for life and her gymnastics sport which she loves and is on a competitive pathway for.

Do not be embarrassed! I have been a doctor for over 20 years and I still regularly get it wrong when guessing which of the patients have sent to x-ray will turn out to have fractures.

Go back. Say:
(1) She was non weight-bearing at the time of the injury
(2) She has been non weight-bearing or partially weight--bearing since
(3) The pain is getting worse, not better
(4) The foot is swollen
(5) She is a competitive gymnast

If you like, you can also say that you have spoken to an acquaintance who is an A&E doctor, who feels that a group 1 talar fracture and subtalar dislocation need to be excluded. (Of course, you only have my word for it that I'm an A&E doctor, and I would never, ever advise anyone to follow medical advice from a stranger on the internet but, in this case, I am only advising you to see a doctor IRL, not on any treatment.)

These injuries are rare in young children but, when they do occur, they are usually from forced twisting of the foot, as probably happened to your DD.

@steppemum

I twisted my ankle a while ago while out walking the dog.

I couldn't stand on it at all, and had to phone dh to collect.
Sat at home with bag of frozen peas and it was so painful. Couldn't weight bear at all, swollen and agony to the touch.

So dh took me to A&E. Due to Covid, he had to drop me off, and then I discovered we needed to be at a different door, and had to hobble 20 yards to the other door. Took me ages, and arrived at the other door, literally crying in pain, and trying to be adult and keep it all together.

Got x-rayed and it was not broken.

I couldn't walk for 2 weeks, and after that, only hobble. Didn't drive for about a month. Pain was awful. Swelling was huge, and when the bruising came out my whole foot was purple.

I know ankles and heels are different, but I am just saying that soft tissue injury can be awful

Yes im so aware it could be this - its just so tricky with a child because as a parent you dont really know whats going on it there.

I would have assumed that most of the time if you have a child presenting the way my daughter did then it would be an automatic xray.

@MissLucyEyelesbarrow Thank you so much i really do appreciate all you have said xx

My ed sprained her ankle many years ago. We didn't get it looked at straight away as thought she would be ok. After a few days we realised she wasn't, took her to a&e, I was asked many times why I didn't take her sooner and I said if I took my kids in for every injury I'd be forever in a&e.
Anyway, her injury didn't heal and she now has a chronic pain condition.
What I am saying is I'd rather a moment of embarrassment and it be nothing, than what she has been through for the past 12 or so years.

Same as what someone has posted but there are IRMER regulations, meaning health care professionals have to provide X-ray department a good rational for requesting X-rays to minimise unnecessary exposure. Hopefully she will get better soon x

"ive potentially damaged her for life and her gymnastics sport which she loves and is on a competitive pathway for."

She will be covered by insurance for the trampolining and they can assess her injuries through that. Look it up - they can give physio, etc.

Is the pain actually in her heel or is it that the pain is in her whole foot when she puts her heel down/foot flat?

The reason I ask is because when I broke the metatarsal bone in my foot I could limp on my toes but not bear weight on my heel or with my foot flat.

@MissLucyEyelesbarrow

I'm an A&E doctor/urgent care GP. It is unusual to break the heel with a fall onto a soft surface but, if 20 years in A&E have taught me anything, it's never to say never.

We try not to x-ray when there is a low risk of a fracture, especially with children, because of the exposure to radiation. If I had seen your DD on the day of her injury, I might not have x-rayed then and there (depending on my examination, obviously), but - if I hadn't x-rayed, I would definitely have told you to come back if there was no improvement within 48 hours.

In your case, the fact that the pain has got worse after 48 hours is a red flag. I would definitely return to A&E and request a consultant review - or go to a Minor Injury Unit if you have one locally that has an x-ray facility .

It is still most likely to be a sprain - they can be extremely painful in the foot. But, if it was my DD, I would want her x-rayed at this point.

I've worked in A&E for almost 20 years and this is the most sensible answer I think I've ever seen on Mumsnet (waves to colleague) 👋

@Darkstar4855

Yes, the qualified doctor can’t possibly know what they are talking about. Complain to PALS, OP

Maybe it was the same doctor who had a right go at me because my elderly DM was admitted by ambulance after slipping out of her chair?

DM had broken her hip. It happens.

@FrangipaniBlue

Is the pain actually in her heel or is it that the pain is in her whole foot when she puts her heel down/foot flat?

The reason I ask is because when I broke the metatarsal bone in my foot I could limp on my toes but not bear weight on my heel or with my foot flat.

It’s all her heel however underneath and over the top of her toes are starting to her sore. I assumed this is due to her walked on her toes/limping for 3 days

@Sixgeese

When DD was 2, DH fell down the stairs while carrying her. I took them straight to A and E as they were both in pain. DH was X rayed and was found to have broken a rib.

They wouldn't X Ray DD, they said at her age it wouldn't be broken, it was a sprain, it would hurt but we were to make her walk in it as much as possible.

After a few days with no improvement I took her to the GP, they agreed with the hospitals assessment, as did a friend who is a GP who I asked for advice.

After 2 weeks and a lot of crying, I noticed her leg seemed to have started bowing. I took her straight back to hospital, where I was made to think I was a neurotic mother. They X rayed her, in part I think to shut me up.

It turned out her leg was broken in 3 places.

I felt so bad, and that was made worse by the people who were plastering it asking why it had taken me 2 weeks after the accident to bring her to the hospital and why hadn't I brought her straight away.

Please do not be fobbed off like I was, if your DC is in pain and you are worried please get it checked out, they can only know whether or not it is broken with any certainty is by x Ray.

I sincerely hope that you told them VERY clearly that you had taken her straight away and that the hospital refused to x-ray. I hate hearing people being fobbed off like this.

Thanks @choosername1234. I'm glad someone appreciates my advice - my patients so rarely do 😉

@Darkstar4855

Yes, the qualified doctor can’t possibly know what they are talking about. Complain to PALS, OP

A qualified doctor told me I didn’t break my knee 13 years ago. Another qualified doctor 5 years later sent me for an x ray and then asked why I never got my historic fracture fixed and that it was now too late. In present day I still can’t kneel on it or weight bear