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Recurrent limb pain in childhood

Worried parents?

We are often approached by parents concerned about their children complaining of painful feet and lower limbs. If this is something that affects your child, then should you be worried?

Children can express pain from a young age, although it can be tricky to identify the source of the pain in very young infants. When it is occurring regularly, or the pain is very intense, it may indicate that a foot assessment might be necessary.

Recurrent limb pain in childhood

Typically, children complain of aching in their lower extremities in the late afternoon and evening. Over the years this has become labelled as “growing pains”. The common and painful condition of “growing pains” has been probably been mistakenly attributed to the growth process for the last 195 years, since it was first described by Duchamp in 1823.

Although pain during activity, in the otherwise healthy child, is clearly a sign that the foot or lower extremity is not functioning properly, the act of growing is not a painful condition in itself. If this is happening, it would probably mean that something abnormal is occurring. There is little evidence in the medical literature to support that the symptoms associated with “growing pains” are caused by the growth process. In fact there is no evidence that the process of growth is painful. The term should be replaced by “Recurrent limb pain in childhood” which is a more appropriate and accurate description.

Muscular Fatigue

The under-fives might complain of their legs feeling tired, rather than painful and parents may notice a prolonged instability of gait, coupled with tripping or falling. This type of situation can occur, for example, in cases of abnormal flexible flat feet (pes planus).

When the feet are not functioning well, it causes the muscles to fatigue. This stress in the tissues results in soreness or cramping in the tendons, ligaments and muscles of the legs. Therefore, a newly walking child may prefer being carried or held and youngsters may protest about walking for longer periods, such as during a walk in the park.

Studies have shown that children with a flexible flat foot deformity also experienced lower extremity symptoms due to growing pains and the vast majority of them found their symptoms resolved with the use of orthotics.

As practitioners, we shouldn’t dismiss these “growing pains” as a normal and transient symptom that all children experience. Podiatrists and Paediatricians must be concerned when these complaints persist for a long time. Moreover, we must be alert to a history of prolonged or excessive cramping. A child who chronically complains of muscle tightness and cramping, to the point where minimal activity causes discomfort or night cramps, should not be dismissed as “normal”.

Children play and run a good deal of their time, much more so than adults. It seems logical to assume that children also experience pain in their extremities that is likely related to their running and playing too much for their individual biomechanical make-ups.

Bio-mechanical examination

We recommend that children experiencing this recurrent limb pain have a podiatrist bio-mechanical examination at least once a year. At Randell’s Footcare we have a fantastic bio-mechanics podiatry team who strongly believe in prevention as the best way to keep our bodies and feet in great condition.

If you have any concerns at all about this topic, our podiatrists would be happy to talk things over with you.

Ivan Maestre,  Podiatrist at Randell’s Footcare

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