“What is causing my daughters leg pain?”
My daughter injured her left leg last December. She went to her PC and they sent her to an orthopedic doctor. They did an X-ray and found no issues. Eventually, after a month she was able to straighten and bend her knee. Fast forward to last Monday her leg started hurting again to the point of limping. I took her to her PC on Thursday and they could not determine a cause. Referred us to an orthopedic doctor. Friday night we noticed her foot was turning purple when she was not elevating her foot. We went to ER Sunday and they did an ultrasound and found no DVT. They then transported her to Boston Children’s hospital and they ran blood work and everything looked normal- white cells slightly elevated but nothing to cause concern. They referred us to a neurologist. The neurologist can’t see her until Nov 30th. I am beyond frustrated. My daughter cannot put pressure on her foot/leg. Any advice would be greatly appreciated.
Female | 17 years old
Complaint duration: 8
Medications: None
Conditions: None
10 Answers
I would be concerned about Complex Regional Pain or what we used to call Reflex Sympathetic Dystrophy
Get rechecked and you are likely to be referred to Physical Therapy, Neurology or Pain Medicine
Best wishes!
Get rechecked and you are likely to be referred to Physical Therapy, Neurology or Pain Medicine
Best wishes!
I would suggest an orthopedic referral and vascular surgery evaluation. Do both. If it is sensitive to touch with sheets and feels cold, there are issues related to the sympathetic nervous system, which may come into play. The two I suggested would be a good starting point.
Any MRI for a specific area (knee, ankle) causing pain or discomfort? Any physical therapy after knee or leg injury? Potentially a complex regional pain syndrome, which usually responds to formal physical therapy.
It's hard to say over the internet and with just pictures without being able to see the foot itself, but I can try to help give you some guidance as far as a few things to maybe look into and see if they apply to her situation prior to other visits. just a few questions to get some additional details.
- any history of her toes or fingers going white and painful especially in the cold?
- is the discoloration associated with the pain or just something new that she is noticing
- does this happen every time she lowers her leg or does it also occur spontaneously?
- is there anything else that can triggers the symptoms (i.e. cold temperature)?
- any numbness/tingling?
- does she have any medical conditions or take any medications?
- where on her leg does it hurt?
- what was the injury in december and what was done?
Answers to those could give me a little more understanding of the situation
- any history of her toes or fingers going white and painful especially in the cold?
- is the discoloration associated with the pain or just something new that she is noticing
- does this happen every time she lowers her leg or does it also occur spontaneously?
- is there anything else that can triggers the symptoms (i.e. cold temperature)?
- any numbness/tingling?
- does she have any medical conditions or take any medications?
- where on her leg does it hurt?
- what was the injury in december and what was done?
Answers to those could give me a little more understanding of the situation
Have they gotten an MRI of her knee/leg? what about arterial ultrasound? I don't think it's a neurological issue. There is an off chance that she may have complex regional pain syndrome, which is a rare condition that may result in similar symptoms, but it's usually a diagnosis of exclusion.
RSD - reflex sympathetic dystrophy
There’s no way to know for sure without evaluating her in person, but it looks like she might have complex regional pain syndrome. It’s really important to start aggressive physical therapy as soon as possible before this develops further.
Looks like a venous obstruction or malformation. Might need a vascular surgeon
There a certain Lee reason for evaluation here. Her current symptoms may be unrelated to the prior injury. A vascular evaluation would be a good idea. Just because there was no DVT does not mean there is not a vascular problem. Injuries can make veins lazy resulting in the symptoms you describe. The injury you related does not seem to rise to that level however. I would incorporate a vascular evaluation with a vascular specialist .I would also revisit with your orthopedic surgeon as well. Best to be thorough
Good afternoon. You did a great job with describing symptoms but would have been helpful to know initial injury and type of pain. By the limited history and exam it sounds like your daughter has a complex problem called a complex regional pain syndrome. In short this is where the nerves in the extremity are affected leading to pain which is worse yeh expected due to injury. It can lead to pain, color and temperature changes in the extremity. They generally resolve or improve with time, can reoccur and medication can be helpful. They are difficult problems always frustrating to patients family and doctors. They are not emergencies but I would try a different doctor and see if you can have your daughter seen earlier. Good luck.
