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Louise Sivak, M.D.
Louise Sivak, M.D., Doctor
Category: Pediatrics
Satisfied Customers: 3499
Experience:  Pediatrician, Board-certified in Ped Hematology/Oncology
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My 11 year old daughter has foot pain on inner side & top of

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My 11 year old daughter has foot pain on inner side & top of left foot, it's gone on for over a week. she can walk and attend school but walks with a slight limp, even when we are not nearby watching her. We have iced, rested, elevated, and we have a foot brace she wears occasionally, from a slight sprain in her opposite foot last year. There has been no improvement nor has it worsened during the week.

I will make an appt for a visit to her pediatrician on Monday. I feel that doc will tell us to continue the "rice" treatment at home for several more weeks. Do you think I should press for an xray of my daughter's foot?

My daughter is one who'd rather tough things out, so for her to complain about this foot pain may be more important than it seems, or I could simply be a mom who is not well-versed in the art of foot care.

Thanks for your time.

Louise Sivak, M.D. :

Hello, Sorry your daughter has this pain. Any injury to that foot or ankle? Is the area red / visibly swollen / bruised? Full movement of the foot and ankle? Any fever or other symptoms?

Customer: Hi, no fever and it's not swollen or red. It hurts when she walks on it and puts her weight on that foot, though, and she says it kind of hurts when her foot is propped up on the couch resting too.
Louise Sivak, M.D. :

Thanks for the additional info. I tend to be very cautious. With no trauma to that foot, in a child /preteen who knows her own body, I would DEFINITELY demand an Xray NOW.

Louise Sivak, M.D. :

You should request (pediatrician knows this) standard 3-view of ankle, plus add'l films of any areas on the top of the foot that are tender on exam.

Customer: Oh, and she can move her foot freely, except for one thing -- when she does an ankle roll clockwise toward the painful side of her foot, she has to stop at about the 2 o'clock position due to the discomfort.
Louise Sivak, M.D. :

I'd also request screening complete blood count / manual differential, basic kidney functions, ESR, LDH, uric acid tests.

Customer: Why the other tests besides an xray? I know about uric acid causing gout because my grandma suffered from that.
Louise Sivak, M.D. :

OK, this is not normal. Without trauma, this is concerning for a viral synovitis, unknown injury (UNlikely in an 11 year old), possible bone infection, possible malignancy. This needs in person attention Mon and Xrays to start with. I recommended screening blood tests above. The other tests (if her treating pediatrician agrees) are screens for leukemia, abnormal liver or kidney function. I am being overly cautious. This is what I'd do if your daughter were my patient.

Louise Sivak, M.D. :

I should add, screening for malignancy but also sub-clinical infection.

Customer: I should also mention that our daughter takes taekwondo classes. But typically if she gets a little banged up from class, it hurts more at first, then feels better much sooner. Even with her sport, I agree with the overly-cautious approach.
Louise Sivak, M.D. :

I agree with that assessment and approach. Also, her pediatrician may identify a clear area of likely strain on physical exam and then recommend with more info a wait and watch approach for another 1-2 weeks. The no improvement concerns me.

Louise Sivak, M.D. :

Would continue with RICE over wkend. If pain wakes her up at night, worsens, or new symptom (like unexplained fever) then recommend your contacting her pediatrician's on call ASAP. Best of luck, and please do let me know,

Customer: May I also add then, daughter experienced similar pain in Nov 2011 but it was her Other Side and more in her ankle ... That was stayed and showed nothing, and eased up after a month.
Customer: Stayed equals XRAYED
Louise Sivak, M.D. :

Good to know, but I still recommend as above. At least see the pediatrician in-person Mon and s/he can examine her and make more informed recommendation. Best of luck to her, Hope she's feeling fine soon,

Customer: Ok thank you . We will see our ped dr on Mon, she is a good doc as are you.
Louise Sivak, M.D. :

All the best, XXXXX XXXXX likely a strain but let's be sure and let's be cautious. take care,

Louise Sivak, M.D. :

Please ACCEPT if I've answered your question, post back as much as you wish, All Best,

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