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9 year old child has a sore ankle/leg. What can I do to help?

52 replies

PavlovtheCat · 04/11/2015 10:13

DD has had some trouble with her legs and feet for a little while. She has quite a prominent in-step on both feet, always has, it has been worse/better over the years at various stages, but never caused her pain, discomfort or affected her walking/running etc. Told as a young child by medical professionals to keep an eye as she grows but likely will grow out of it and also if it doesn't cause her problems it probably won't be addressed in any way.

Over the last few months, she has complained that her knees knock when she runs, and when playing some sports such as hockey her ankles have been hurting, more in her right leg/ankle. Also that her thighs hurt a little.

It's got worse over the last months, to the point that now when she walks, her feet turn very inwards (right in particular) after a while, and she can turn both ankles/feet completely the other way. After walking quite short distances she is in some pain and is starting to not want to do activities that require walking/running/moving.

Saw GP (locum) a couple of months ago who said it was perfectly normal and nothing to worry about. As it got worse, I took her back a couple of weeks ago, especially after she showed me how she could turn her feet backwards on themselves. GP has referred to physic for an assessment, but says he thinks its probably just that she has had a growth spurt and that her muscles/ligaments haven't caught up yet, so pulling her feet in slightly, and causing it to hurt. He said physio will check to see where the instep comes from (i.e., hips, knees or ankle themselves) and likely give her physio exercises to strengthen muscles/ligaments if it's what he thinks is the case.

He doesn't think it's joint hyper mobility syndrome as she can't bend her thumb backwards and has no hyper mobile joints anywhere else that we can tell.

She is off school today as her right ankle and lower leg is so painful she can't bear weight on it. It has been steadily building over the last few days, and by last night she was crying in pain, woke in the night with pain (not usual) and sobbed at the prospect of going to school (not usual for her either). It hurts to bear weight, but also to turn the ankle and move it - it hurts around the ankle and up the leg on the lower part of her lower limb. Her left leg hurts a little but nowhere near as bad as right leg.

Called physio today, they have a cancellation for tomorrow, and she is going in for that appt.

In the meantime, what can I do to help with the pain? She has been having calpol and ibuprofen alternating for the last few days, but by last night it didn't do a huge amount. Have used ice pack, which eased it a little.

Can I strap it? How would I do that? Anything else I can do to ease it for her? Didn't want to take her to docs today, as it's another locum who I saw myself this week and she was a bit useless to be honest so didn't see the point of taking her today.

OP posts:
imip · 04/11/2015 23:09

Op, dd8 suffers from hyper mobility syndrome. It began around 2 yrs ago, and was so severe she could not walk. Initially it was diagnosed as arthritis, it had a severe impact on her mobility.

She is not hypermobile in all joints, and experiences pain mainly in her ankles and wrists. She had a lot of biomechanical pain as a result of this.

The few things that had the greatest impact on her pain levels include getting scent trainers. She wears asics (generally the Gt-1000), with orthotics, regularish physio and keeping active but at the same time pacing her activity.

She still suffers from pain daily, but it is not as painful as it has been and she generally does give everything a go (eg, p.e. At school, she plays violins, does gymnastics and swimming). I'd credit the shoes, stability trainers, as being THE thing that contributed the most to her improvement. Podiatrist and physio did suggest clarke/start rite to me, but decent trainers really did it, she wears them instead of school shoes, school are ok with it. They need to be stability trainers, with EVA foam (the grey part of the trainer).

imip · 04/11/2015 23:10

Decent trainers, not scent trainers - apt, however Smile

Toffeelatteplease · 04/11/2015 23:12

Any chance of a link? I haven't heard of them and may well be of interest to us to.

AnyFucker · 04/11/2015 23:13

have a look here

there are parent info leaflets on symptomatic hypermobililty, choosing children's footwear and intoeing gait (amongst others)

having a read may assist you in the consultation with the physio

Toffeelatteplease · 04/11/2015 23:13

Blush I Googled scent trainers

Toffeelatteplease · 04/11/2015 23:14

Yes that's it! That's the leaflet we use for shoe shopping!

PavlovtheCat · 04/11/2015 23:18

thats great thank you AF

i almost went off to google Scent trainers too Grin i have heard Asics are good before, I shall brace myself for a big hit in the wallet Grin

OP posts:
imip · 04/11/2015 23:43

asics trainers

Not all that expensive at all given how crucially they have helped dd!

PavlovtheCat · 04/11/2015 23:48

oh thats a good price! they don't look too clunky either like some trainers can

OP posts:
Footle · 05/11/2015 22:40

OP, I hope something helpful came out of your daughter's appointment today.

PavlovtheCat · 06/11/2015 01:06

footle thank you for checking. finally got a moment to myself Grin

DD saw physio who happens to be related to someone we know so put her at ease straight away, a lovely woman, spoke directly to DD most of the time, with me confirming/backing up/elaborating/filling in gaps.

She said that all children are to some extent or another hyper mobile in some joints, due to the constant growing and stretching. She doesn't think that DD's current problem will be a longstanding hyper mobility problem, and also that there is no issues with the alignment of her hips etc. But it's too early to tell for sure.

She said that her calf/back muscles are very tight, and the muscles at the front/shin are weak, in particular on her right side, and that is very likely because she has had a particularly big growth spurt, said that children will often have small periods of aching legs, which is 'growing pains' as the muscles take a little longer to catch up, and some children (i.e. DD) have more problems with this, that the bone growth vs the muscle and ligament growth are significantly different for a short while. If not addressed it can cause problems later as the muscles can remain weak/tight for too long, but it's rectifiable now. The instep is very pronounced on her right foot in particular and she said that the reason she can twist her feet all the way in the opposite direction is due to the lack of strength in the muscles.

Also has weak hip muscles, for the same reason, but that many children have this, and when they exercise they don't do specific exercises to address specific muscle groups, children just do lots of fun activities, unlike adults who build specific muscle strength.

So, 4 exercises to start with, to build hip muscles, and ankle/leg muscles, to stretch out the calf muscles, and to help with encouraging her feet to turn outwards. She said there are more, but that she doesn't want to add too many as if it causes more pain than good she can tell more easily what is working and what isn't.

There is a group class in the gym with children, with all different reasons for being there, and said she thinks DD will benefit from this if she gets on with the exercises. but if they hurt too much, she will do the exercises with her in a hydrotherapy pool.

She assured DD (and me that there is no actual damage to her muscles or her ligaments, and although her legs might ache afterwards, the exercises are not doing her any damage, and it's going to take a little bit of time, but that she will feel much stronger in time.

Advised for her to keep swimming, and to not avoid activities where possible, but be guided by her pain levels, particular over the next couple of weeks as she starts the physio exercises. Said she should do PE and stop early if needed etc.

Back in two weeks to review and build on the exercises.

She said that further down the line we will have a clearer picture of whether this may be a longer term issue, but she thinks it's likely linked with growth.

She also mentioned hormones, can't remember who said that! And she is definitely having a surge of hormones atm!

Thank you all so much. I will come back to this from time to time to remind myself of some of the info you have all given me, re shoes, tips for managing the aches etc.

OP posts:
Babbafish · 06/11/2015 02:00

We are an EDS type 3 family !!!!! I think your DD Has hypermobility!!!
My DS1 can turn elbows inside out, DD1 can rotate 360 from the knees and DS2 needs AFO's just for ankle support! It effects is all differently with same dx!!!!!
Sound like your DR needs to meet my family !!! DH is not hypermobile in anyway ..... He calls us wobbly-tickles!!!!

PavlovtheCat · 06/11/2015 09:03

What are AFOs? I personally think that it's a bit more than just being a bit bendy and growing, but, either way, whether it is or it isn't, these exercises would be the same I should think? And like all diagnoses, it takes time to get one, so I have found anyway!

I asked about shoes, she said, sturdy ones with support over the top of the foot i.e. buckles or velcro, no need specifically for boots at the moment, but flip-flops are a no-no. DD has never had flip flips because I have always been worried that she'll stand on the back of them and fall over, or stub her toes as they are long.

Interestingly, she said to the physio, and I knew this, but never considered it before, that she can bend her toes backwards! She was mentioning it because she smacked a toe quite hard a while ago and now she can't bend it back like the others and was talking about this. Some of my toes can bend backwards, and the ones that can't is because I broke them (suspect) over the years as my second toe is longer than my first. I also used to be very bendy as a child, but nothing noticeable, just able to get my legs around my head, could crab (it's called bridge now?) easily, arch backwards to almost touch the floor which my head, touch the floor with my palms that kind of thing but that as just normal stuff to me. Not a chance now though, I can barely bend at all and can only touch the floor with my palms if I am sitting on the floor!

OP posts:
Footle · 06/11/2015 15:12

It's good to hear that things have moved on from yesterday, with an approachable physio involved - the GP did help. I hope the hypermobility does turn out to be a short -term thing. Now that it's being taken seriously your daughter should find it easier to remain as comfortable as poss. Here's hoping.

PavlovtheCat · 06/11/2015 16:00

thanks footle. It's going to take some time, and the exercises are hurting her, but she will get stronger as long as we keep up with them, I think.

OP posts:
Toffeelatteplease · 06/11/2015 17:36

Good luck.Flowers

PavlovtheCat · 06/11/2015 17:40

Thank you toffee and thanks for all your advice. Flowers Star

OP posts:
PavlovtheCat · 12/11/2015 21:56

just sort of touching base again, in case anyone's about.

DD has been doing her exercises, gently, not as many reps as she needs to be building up to, and have missed the odd session, so most days twice a day, a couple of days only once.

She is in a lot of pain when she does them, and after. Also, activities that require using her legs are causing her discomfort. We went swimming today as she miss her lesson this week. She mostly jumped about and splashed and swam about with her brother, did a couple of short widths to practice butterfly. This evening, she is in pain when she stands, crying with it, and in bed, whimpering a little. I am out of bloody calpol too Sad (DH will pick some up on the way home). I've given her a warm gel pack to rest on her ankles, which hopefully has given her a little relief as she is now asleep.

I know it's going to take a while for her muscles to strengthen, and that physio said her muscles will ache after doing the exercises, but really, I can't bear to see her suffering. Just thought I'd see if anyone could give me some positivity about it all, so I can feel confident this will improve, then I can properly help her feel confident that it will too. She is now wanting to avoid activities that involve walking or using her legs.

I have been watching her walk, and she wiggles at her hips. When the physio looked at her walking and running, she was, I think, concentrating on her feet, and her hip movements were not very obvious as she had a free flowing pinafore dress on. I might ask her to look again. She is going to a children's group exercise class in just over a week, so will see physio then.

OP posts:
Toffeelatteplease · 13/11/2015 02:00

A question:

Did the physio explain what they were working on and how? A lot of you explanation seemed to be missing out the why, and I get the sense that you would get it had you been told so probably you haven't been told.

Without an explanation it's probably easiest to explain it like this

You work on different things in different ways. If it was a sprain or recurring sprain it wouldn't surprise me if it hurts after a session. So when DD had physio for a recurring sprain (after an injury) she would need rest and painkillers that evening. And maybe still painkillers the next day especially if she had PE. but it would be manageable with pain killers. Crucially the physio told me exactly what amount of pain to expect and when it should ease off. She was right.

DS when he has physio (hypermobile joints, low muscle tone, fatigue issues, dyspraxia) will be exceptionally tired after a sessions. Maybe into day. He doesn't respond normally to pain but I would say pain isn't the predominant feature at all. The best physio he had, her sessions looked frenetic. She was genius at spotting the point he genuinely could do no more and switch to either something different or a more passive exercise. He would be exhausted well into the next day but what she achieved for muscle tone was tremendous.

I had physio when a child for a pain condition. The wrong physio left me in agony (many years later she did actually apologise) the right physio left me sore but not excruciating.

So what im trying to say is that whilst physio can involve a some pain, I'm not keen on physios that see the pain barrier as something that you smash through. I wouldn't wait but would have a chat with the physio sooner. I would have thought your DD would have been closest to my DS need for physio. In the end he like your DD has to get on with it between sessions, if you whack a child out so considerably that they can't function between sessions I wonder what you are realistically achieving.

The best thetapist's will give you a rationale for why they are treating something the way they are.

Toffeelatteplease · 13/11/2015 02:09

I will add the first physio DS had was appalling, tried to discharge DS several times and didn't listen to my concerns at all. It took a couple of private physio reports and me nearly taking her career down in the process, before they started treating DS with a lot more care. So always trust your gut

Toffeelatteplease · 13/11/2015 06:11

I wonder if you need referral to paediatrics as well.

It bothers me you don't have a why is she in so much pain

PavlovtheCat · 13/11/2015 08:51

toffee she has explained the why as being that her muscles at the front are weak, and the muscles at the back are too tight, due to a growth spurt. She said that she would expect her muscles to ache afterwards, rather than be painful, but that if it was painful she would do hydrotherapy with her. She wants the muscles to stretch at the back, and get stronger at the front, and to build her hip/butt muscles up, and I think the exercises she has given her do match that (bridge for hips, standing on one foot for as long as possible, and a stetting exercise standing against a wall with one knee bent and the other leg straight behind it - that one hurts the most). And she is more tired, she is more cuddly/and needy like she is when poorly after any exercise. Feeling down.

Her legs, ankles and just above in particular are sore today, but, it's not the whole muscles that are sore, the calf muscles for example, it's the actual ankle area itself, she can press on a particular spot and it hurts more, I think it's where the ankle rotates.

I think I will speak to the physio again before her next appt. DD does winge a little more than she used to about pain and bashing bones etc, she used to just get up and walk away, think there is an element of growing older and using it as a reason to do or not do things, but really I don't think that's the case with her feet/legs.

Thanks for your really helpful posts, really appreciate it. It's a new area, and a minefield for me. I don't want to be unnecessarily pushy if we need to give it time, but neither do I want her to hurt so much.

OP posts:
Toffeelatteplease · 13/11/2015 09:26

I recognise some of those exercises with DS. Grin

If she has offered hydro thats incredible push for that. (Would love to have that for DS)

Definitely feed back because if looks more like the wrong level of challenge. She may need something easier to get started. The excellent physio i mentioned knocked DS out for 2/3 days first time, she adjusted very quickly as she got DS' measure. Sometimes they give you a freak exercise that is way more harder than the rest. The bridge stands out for me out of your lot. Again feed it back and the physio should be able to adjust and simplify.

Also Watch carefully while she does the exercises to make sure that she is using the correct muscle groups to do the exercise else it will hurt (I ask what am I looking to see, if I touch which muscles should I feel loosen and contract, is there any way of "cheating" I should look out for).

And yes I would definitely mention about the specific spot.

Toffeelatteplease · 13/11/2015 09:47

For example the "pushing the wall exercise" check for cheating things like

  1. that you are not dropping the hip on one side.(Usually dropping towards the back leg) 2)that while the back leg is straight the knee is soft and not fixed. If you are hypermobile in the knee joints at all, one of the (bad) ways you create stability is essentially by pushing the knee joint back. Causing pain in the knee joint.
  2. that neither leg is rotated- unless it is meant to be

They might make the exercise easier to do but you are not exercising what you are meant to be!

Toffeelatteplease · 13/11/2015 09:51

Particularly if you are hypermobile you are looking for a sensible speed and control in all of the exercises. It is easier to do them quickly because you don't need as much control. That will apply particularly to the bridge