CRPS in 8yo post ankle sprain

[Kineari]

Hello, I am a physiotherapist working in the french countryside with a patient list similar to an outpatient setting so I see a lot of backs, knees and shoulders etc!

I have recently taken on an 8yo girl who 2 months ago sprained her ankle (no swelling or bruising after) and has developed an algodystrophy in her ankle and foot.

She is non-WB, mobilising with 2xEC and has been since the accident. Diagnosis of cold stage algodysptrophy by Scintigraphie (is it the same word in english?!). There is slight sswelling of the foot and ankle and can have discolouration but no abnormal sweating or hair growth.

Assessment of pain is quite tricky to get an accurate idea, but sole of the foot and toes are extremely painful to light touch/tissue(10!) with heel/ankle and top of foot slightly less painful. She does tolerate wearing a sock and has been wearing a medial/lateral splint since the sprain. She is able to tolerate tepid water baths and apparently has been to the swimming pool with the injury.

ROM is pretty poor but again difficult to accurately assess due to pain on touch. Minimal AROM in IP jt of big toe and some PROM DF/PF at the ankle, some reflex movement in toes and ankle when stroked across sole of foot.

I have very little experience with CRPS let alone in children so if anybody has any bright ideas or treatment options I would be extremely grateful!

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[mmwr715]

Kineari,
There's a recent free summary of treatments for CRPS in children here:
Weissmann R, Uziel Y. Pediatric complex regional pain syndrome: a review. Pediatric Rheumatology Online Journal. 2016;14:29. doi:10.1186/s12969-016-0090-8.
Pediatric complex regional pain syndrome: a review

However, physio by itself apparently works well and a recent program just used home based physio:
Iowa Orthop J. 2015; 35: 175–180.Outcomes of a Simple Treatment for Complex Regional Pain Syndrome Type I in Children. Frederick R. Dietz, MD and Stephen P. Compton, MD
http://www.ncbi.nlm.nih.gov/pmc/arti...J_2015_175.pdf

Their instructions included take home plan:
Treatment Plan for Reflex Sympathetic Dystrophy
1) Massage 3-5 times/day
2 minutes firmly
1 minute lightly
2 minutes firmly
2) Focus on the body part that is causing you pain and talk to it while massaging.
3) Always keep it moving, never let it be still.
4) Use it! Walk, run, jump and play as soon as possible.
**Remember, it will hurt worse at first but it will get better!
---
It is important to take vitamin C in CRPS:
Vitamin C Strikes Again – ?Prevents Post Surgical Wrist Complex Regional Pain and Obviously Post Foot/Ankle Surgery CRPS
Vitamin C Strikes Again – ?Prevents Post Surgical Wrist Complex Regional Pain and Obviously Post Foot/Ankle Surgery CRPS | Pain Medical MusingSoaks in Dimethylsulfoxide (DMSO) 50% (diluted horse linament) could help:
Pain. 2003 Apr;102(3):297-307. The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. Perez RS1, Zuurmond WW, Bezemer PD, Kuik DJ, van Loenen AC, de Lange JJ, Zuidhof AJ.
The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. - PubMed - NCBI

Good luck
Mikem MD
painmuse.org