Unexplained toe pain in a child
March 2, 2017 10:34 AM Subscribe
My 8 year old niece is struggling at the moment with very painful toes on one of her feet. She has seen several specialists, who haven't managed to identify the problem. What could be causing this?
The toes on one foot hurt most of the time, but they seem to be particularly painful when touched (even very gently), and when she walks or runs. Externally, the toes look perfectly normal -- there is no sign of any rubbing (e.g bad shoes) or deformity or swelling. However, she is struggling to sleep because of the pain, and can't do activities that she normally enjoys, which suggests the problem is not imaginary.
The toes on one foot hurt most of the time, but they seem to be particularly painful when touched (even very gently), and when she walks or runs. Externally, the toes look perfectly normal -- there is no sign of any rubbing (e.g bad shoes) or deformity or swelling. However, she is struggling to sleep because of the pain, and can't do activities that she normally enjoys, which suggests the problem is not imaginary.
Do you know what they've ruled out? How long have they been hurting?
Any chance it could be gout?
posted by purple_bird at 10:56 AM on March 2, 2017 [2 favorites]
Any chance it could be gout?
posted by purple_bird at 10:56 AM on March 2, 2017 [2 favorites]
Does she live in an area where Lyme disease is common? I got to the x-ray phase of checking out toe pain before thinking to ask for a test, and having that be the answer.
posted by gnomeloaf at 10:56 AM on March 2, 2017 [2 favorites]
posted by gnomeloaf at 10:56 AM on March 2, 2017 [2 favorites]
What kinds of specialists has she seen so far?
posted by showbiz_liz at 10:58 AM on March 2, 2017
posted by showbiz_liz at 10:58 AM on March 2, 2017
Pain, even with gentle touching, sounds similar to my uncle's gout.
posted by backwards guitar at 11:13 AM on March 2, 2017
posted by backwards guitar at 11:13 AM on March 2, 2017
Best answer: It sounds rather like arthritis or a stress injury also. If the pain is in the toes make sure that she has shoes that are thick-soled and low heeled with room inside to wriggle her toes. She may have gotten a pair of pretty shoes that fit but don't really, as they are built too narrow.
Don't omit helping her with heat and icing the sore area. If that helps it can give you a clue as to the source of the problem.
Is the foot that hurts the one that she leads with when jumping over something so wide that she spreads her legs to do so?
Does she get any relief from massage of the foot, or elevating the foot? Doing that before or when she is in bed may help with the getting to sleep.
Has she been playing sports in school that she is not used to?
Is her second toe longer than, or as long as her big toe? That can cause stress in the ball of the foot because of the weight distribution, and the pain can radiate into the toes. It's called "Morton's Toe".
Can she move her feet comfortable when she is in bed, and are the covers pinning her feet down? If she sleeps on her back and the bottom of the covers are tucked in firmly that can also cause sore feet.
Is the skin on her feet very dry? Could she have in-grown toenails that cause the nails to press into the tissue beside them while she is wearing her shoes, but when she is barefooted and having her feet examined do not press into her skin because there is more room out of the shoe.
Get her to stand barefooted and lean ever so slightly forward. In a healthy foot the toes do not touch each other at all in this position. If they do touch she has been wearing shoes that are too tight and have been deforming her feet. However... virtually no adults in this culture have this gap between their toes because of the design of our shoes, especially women. They just don't make shoes that are shaped like a healthy foot.
Put her in sandals without toes for a couple of weeks to see if the problem improves.
Exercises using her toes like fingers may help. Different exercise, such as pleating a towel that is lying on the floor with her toes, and trying to pick things up with her toes, and raising her toes one at a time while her foot is flat on the floor may cause improvement. These exercises, of course should be a game.
posted by Jane the Brown at 11:40 AM on March 2, 2017 [5 favorites]
Don't omit helping her with heat and icing the sore area. If that helps it can give you a clue as to the source of the problem.
Is the foot that hurts the one that she leads with when jumping over something so wide that she spreads her legs to do so?
Does she get any relief from massage of the foot, or elevating the foot? Doing that before or when she is in bed may help with the getting to sleep.
Has she been playing sports in school that she is not used to?
Is her second toe longer than, or as long as her big toe? That can cause stress in the ball of the foot because of the weight distribution, and the pain can radiate into the toes. It's called "Morton's Toe".
Can she move her feet comfortable when she is in bed, and are the covers pinning her feet down? If she sleeps on her back and the bottom of the covers are tucked in firmly that can also cause sore feet.
Is the skin on her feet very dry? Could she have in-grown toenails that cause the nails to press into the tissue beside them while she is wearing her shoes, but when she is barefooted and having her feet examined do not press into her skin because there is more room out of the shoe.
Get her to stand barefooted and lean ever so slightly forward. In a healthy foot the toes do not touch each other at all in this position. If they do touch she has been wearing shoes that are too tight and have been deforming her feet. However... virtually no adults in this culture have this gap between their toes because of the design of our shoes, especially women. They just don't make shoes that are shaped like a healthy foot.
Put her in sandals without toes for a couple of weeks to see if the problem improves.
Exercises using her toes like fingers may help. Different exercise, such as pleating a towel that is lying on the floor with her toes, and trying to pick things up with her toes, and raising her toes one at a time while her foot is flat on the floor may cause improvement. These exercises, of course should be a game.
posted by Jane the Brown at 11:40 AM on March 2, 2017 [5 favorites]
Has she been tested for juvenile rheumatoid arthritis?
Several years ago I had extremely bad toe pain out of nowhere, and my doctor said it was probably one of three things: hairline fracture, rheumatoid arthritis, or (very unlikely) gout. I was tested for all of these things and it remained a total mystery. I got some heavy duty prescription aleve, took it for a week, and eventually the pain disappeared. Still no idea.
But. Check out JIA.
posted by phunniemee at 11:43 AM on March 2, 2017 [2 favorites]
Several years ago I had extremely bad toe pain out of nowhere, and my doctor said it was probably one of three things: hairline fracture, rheumatoid arthritis, or (very unlikely) gout. I was tested for all of these things and it remained a total mystery. I got some heavy duty prescription aleve, took it for a week, and eventually the pain disappeared. Still no idea.
But. Check out JIA.
posted by phunniemee at 11:43 AM on March 2, 2017 [2 favorites]
What test have they done to attempt to diagnose it? My podiatrist wasn't able to diagnose my hallux rigidus with an x-ray, but an ultrasound at my rheumatologist's did the trick.
posted by metasarah at 12:17 PM on March 2, 2017
posted by metasarah at 12:17 PM on March 2, 2017
Nthing the shoes-too-tight suggestion: I've had mysterious undiagnosable bad foot pain that went away when I bought wide shoes. (And at that age, my feet outgrew my shoes *amazingly* rapidly.)
posted by telophase at 1:04 PM on March 2, 2017
posted by telophase at 1:04 PM on March 2, 2017
When I was a young teen I developed such bad pain in my big toe that I was hospitalized with suspected osteomyelitis. After a month (!!) of IV antibiotics I was referred to a rheumatologist who diagnosed me with juvenile rheumatoid. Which is a roundabout way of saying what Phunniemee said, but also I learned as a kid that osteomyelitis is not uncommon in children.
posted by nerdfish at 1:23 PM on March 2, 2017
posted by nerdfish at 1:23 PM on March 2, 2017
Response by poster: Thanks for these great suggestions! To answer various questions: She has had this problem for a few months, though it has got worse recently. She has had blood tests done (though I'm not exactly sure which), and nothing interesting was found. So far she has seen a paediatrician and physiotherapist, and is going to a foot clinic next week. Heat and ice don't help, though sometimes just holding the foot (no pressure) does.
posted by beniamino at 3:02 PM on March 2, 2017 [1 favorite]
posted by beniamino at 3:02 PM on March 2, 2017 [1 favorite]
I'm not a doctor, but pain from touch made me think you could ask about CRPS (complex regional pain syndrome)
posted by andoatnp at 8:56 PM on March 2, 2017
posted by andoatnp at 8:56 PM on March 2, 2017
Response by poster: Thanks again for everyone's help. She saw another doctor a couple of weeks ago, who identified the problem as limb length discrepancy (one leg longer than the other). She now has a thick insole to put in one shoe, and the pain has completely gone!
posted by beniamino at 12:55 PM on April 1, 2017 [4 favorites]
posted by beniamino at 12:55 PM on April 1, 2017 [4 favorites]
This thread is closed to new comments.
posted by gudrun at 10:56 AM on March 2, 2017