Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Swollen Ankles And Foot Pain In A Teenager
Question: My 13 yr old daughter has had swollen ankles and foot pain for two weeks. The swelling got gradually worse until she could not comfortably wear her shoes or walk or run normally. The swelling has subsided, but it is not entirely gone. She still has foot pain which is no longer constant, but when she has it is she describes it as similar to hitting your funny bone. Yesterday she felt good during the day, but then the pain started on the bottom of one of her feet when she was in bed. Putting pressure on the area seems to help the pain. She also had a terrible muscle spasm in her neck and continues to have neck pain. Our pediatrician has run blood and urine and everything has come back normal. We also went to XXXXXXX Children's hospital emergency room, and they performed a chest x-ray and EKG which were also normal. Yesterday we saw a rheumatologist at Children's who said she thought it might be arthritis because when she pressed on the foot and ankle the pain seemed to be at the joints, but she also said it did not fit neatly into the arthritis category. She prescribed IC Naproxen 500 MG 2X per day. Both her pediatrician and the rheumatologist thought there was a possibility of a virus because she did have a headache and did not feel well for a few days at the end of the first week of swelling. I have a first cousin with Dystonia and a grandmother with Parkinson's on the same side of the family. My cousin went undiagnosed for years because all of her tests came back normal. She has had 10 operations and was bedridden for two years after which point she had to learn to walk again.
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
You do not seem to make a specific question, but I suppose you are wondering whether with the family history of movement disorders like dystonia and Parkinson's there is a possibility of this being some type of movement disorder as well.
Judging from your description that doesn't seem to be the case, certainly no indication of Parkinson's and that swelling on both sides is not typical for dystonia either.
I would say it does seem to a case of juvenile arthritis as the rheumatologist has said. The specific cause of arthritis is difficult to pinpoint there are no tests for that but because in many cases a preceding infection has been present it is supposed to be an infection like a virus. The infection is thought to trigger an abnormal immune response which damages the joints.
It is a diagnosis made only from history and examination. There are no blood tests to make the diagnosis, differently from adult forms of arthritis where in the blood is found the rheumatoid factor, in the juvenile form that is usually missing.
The first step in treatment is with anti-inflammatory medication like Naproxen, only if symptoms do not improve (in this case fortunately there seems improvement has begun) are other drugs which suppress the immune system used.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
You do not seem to make a specific question, but I suppose you are wondering whether with the family history of movement disorders like dystonia and Parkinson's there is a possibility of this being some type of movement disorder as well.
Judging from your description that doesn't seem to be the case, certainly no indication of Parkinson's and that swelling on both sides is not typical for dystonia either.
I would say it does seem to a case of juvenile arthritis as the rheumatologist has said. The specific cause of arthritis is difficult to pinpoint there are no tests for that but because in many cases a preceding infection has been present it is supposed to be an infection like a virus. The infection is thought to trigger an abnormal immune response which damages the joints.
It is a diagnosis made only from history and examination. There are no blood tests to make the diagnosis, differently from adult forms of arthritis where in the blood is found the rheumatoid factor, in the juvenile form that is usually missing.
The first step in treatment is with anti-inflammatory medication like Naproxen, only if symptoms do not improve (in this case fortunately there seems improvement has begun) are other drugs which suppress the immune system used.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My question about arthritis is - aren't the symptoms supposed to be worse in the morning? In my daughter's case the swelling and discomfort seem to be less in the morning and more as the day goes on. What about the foot pain in the middle of the night - is that typical of arthritis? Again, when the rheumatologist asked my daughter to run down the hall she felt immediate pain after. Is this consistent with arthritis? The rheumatologist said that she was leaning to a diagnosis of arthritis but admitted that it did not fit neatly in that category. What are your thoughts?
In addition, there is still the issue of the neck spasm and neck pain. The swelling in the ankles and feet have improved, but the neck pain is still an issue. Do you see that as unrelated?
Thank you.
In addition, there is still the issue of the neck spasm and neck pain. The swelling in the ankles and feet have improved, but the neck pain is still an issue. Do you see that as unrelated?
Thank you.
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional information.
It is true that arthritis symptoms are more marked in the morning. That feature is somewhat atypical. The rest can be encountered, neck pain and spasms may happen as spinal column joints may be involved by inflammation as well. While that timing of the symptoms is not typical though there are still atypical cases. I still think juvenile arthritis to be the most probable cause.
That is also by exclusion, as it doesn't look like a neurological issue and normal blood tests should have excluded other issues such as leukemia, infective arthritis, kidney issues etc.
Arthritis as a term means simply inflammation of the joints and I do not think that was what the rheumatologist was unsure about as it is easily diagnosed by localization and inspection. I suppose what he felt uncertain was the cause of the arthritis, which is often unclear, as I said thought to be viral.
Read below
Detailed Answer:
Thank you for the additional information.
It is true that arthritis symptoms are more marked in the morning. That feature is somewhat atypical. The rest can be encountered, neck pain and spasms may happen as spinal column joints may be involved by inflammation as well. While that timing of the symptoms is not typical though there are still atypical cases. I still think juvenile arthritis to be the most probable cause.
That is also by exclusion, as it doesn't look like a neurological issue and normal blood tests should have excluded other issues such as leukemia, infective arthritis, kidney issues etc.
Arthritis as a term means simply inflammation of the joints and I do not think that was what the rheumatologist was unsure about as it is easily diagnosed by localization and inspection. I suppose what he felt uncertain was the cause of the arthritis, which is often unclear, as I said thought to be viral.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
