Question
My 15 year old son walked to school as normal on 6 June and later that morning the outside of his right ankle (the sticky out bone) felt sore.  By lunchtime he could not weight bear as the pain through his ankle and the top of his foot was so bad.  An x-ray was inconclusive but he was treated for a small fracture near his growth plate.  He was placed in an air cast boot for four weeks.  At the review and another x-ray we were vaguely told it might take longer to heal and to wear the cast for longer.  After 11 weeks and an MRI (which was clear) they took the cast away and told my son to just walk.  He cannot as the pain is unbearable.  We have now been told he has a hypersensitive joint and needs physio and rehab to walk again.  I am concerned that as he had never had an injury is this really the right diagnosis - could it be something else?  and is it possible to just develop a hypersensitive joint without injury?  Any help or advice you could offer would be greatly appreciated.  We are currently waiting an appointment with a neurologist as my son was also diagnosed with T1 diabetes in March.  He has very good control though and an excellent HB1AC result so his team do not think it is related to diabetes.  Many thanks

Answer
Hi, Karen,

Thank you for writing.  I'm so sorry to hear that your son is experiencing so much pain!  We never like to see our children suffer.

As I read what you have shared, I admit that there is no single, certain answer I can give you.  In fact, my response is slightly delayed because I was consulting with another physician.  Growth plate injuries are difficult to diagnose, and whenever there's any suspicion, it is better to treat as if there has been an injury.  If he was resting, icing the area, taking an anti inflammatory like Motrin or Ibuprofen, and keeping it immobilized by wearing the boot, a growth plate injury would typically get better.  I agree with the MRI and would only recommend that you get a copy of the images on a CD and have more than one doctor review it.  Some conditions can be difficult to read, and something could have been missed the first time.  Depending on how long ago the MRI was done, either a second MRI or a bone scan might also be helpful.

If your son was instructed to walk and go through rehab to get that joint moving, it sounds like they are suspecting CRPS, or Complex Regional Pain Syndrome.  It's a very confusing, poorly-understood condition that can begin with absolutely no history of trauma.  And they're right, rehab (although excruciatingly painful) is absolutely essential.  You might want to ask if the doctor can do a nerve block.  That might help them confirm their diagnosis and it might relieve some of your son's pain, at least temporarily.

Is that part of his foot hot or cold?  That could be a sign of CRPS, or it could be something else.  If it's not a problem with the bone, or a hypersensitive joint, my other thought is that there could be some sort of infection.  Was he sick or feeling unwell at any point (maybe even a few weeks or a month previously) before the pain began?  Infection can come from the outside, if you get a cut or scratch, but sometimes it can travel through the blood and get into a joint, where it causes something called septic arthritis.

I'm sure your doctor has considered these things, but you might want to make another appointment and bring up some of the things I mentioned, just in case.  I hope this helps, and I wish you and your son full answers and a complete recovery from whatever it is that's going on.

Take care, and best wishes,
Dr. Bodart