8yr old son - brain haemorage then DVT in leg - residual right foot /calve problems

On 1st July (ie about 2.5 months ago) my 8 yr old son had a brain haemorrage - mercifully it was successfully treated...and he came out of that bit very well.

While being treated for the brain haemorrage (they glued the vessels in his brain to stop the bleeding), they entered his through a vein in his groin. Alas he then got a blood clot in his vein in his right leg relating to their entry point.

There was a little bit of left side weakness relating to the heamorrage (which was on the right hand side of his brain), but that seems to have remedied itself...what's had the most impact is the blood clot.

First he couldn't straighten his leg...or put an weight on it whatsoever....after 6 weeks of twice daily blood thinning injectioons, the clot has now all but gone ....he can straighten his leg & walk slowly. But during these past few weeks, his right leg has caused no end of heartache....first his brother fell on his right foot (the sore one), then he fell of his scooter quite badly (we didn't see the accident but he couldn't walk for about 9 days after it), just as I thought it was getting better, I took him swimming (thinking this was gentle excercise). After the swimming we went to the park...and on the way home he started limping. The next day his right foot was in a lot of pain...I just put this down to me overworking it...but it hasn't got that much better in over two weeks now.

I've noticed he is walking on the outer edge of his right foot (with his big toe pointing upwards)....I've established this is because the arch in his foot pad is very sore (ie the metatarsal area)...I took him to the hospital and the X-RAyed his foot & leg (which showed nothing untoward) - if I press the underside of his foot, he really flinches. Also his calf muscles are very sore to press/massage. I've done a lot of googling....and the best I can come up with is that he might have Metatarsalgia, I found this on the net ....

"This condition refers to pain under the ball (front) of the foot when walking. This can be caused by local arthritis, nerve entrapment, excessive pressure on the forefoot, foot imbalances, tight calf muscles resulting in reduced range of motion of the ankle, pes cavus (high arch), pes planus (low arch), poor quality shoes, worn shoes, or poorly fitted shoes, bunions, hammertoes, overuse syndrome, callus formation, and obesity. Many individuals try treat themselves with varying degrees of success, but proper medical evaluation is necessary to develop a treatment plan relieve the symptoms, which if left unchecked, can become chronic."

that's my bold, as his calf muscles are clearly very sore - hardly surprising bearing in mind he hasn't used the leg properly in over 2 months.

Sorry for the long winded story...we have a referral to a physio, but this might be a couple of weeks away and I'm just wondering if there's anything I can be doing in the meantime? (or is there anything else that his foot soreness could be put down to?)

Many thanks,
Pesky.

You have all been through a lot! Hope you find things improving rapidly in the future.

To double check, the DVT was in the left leg?? The right has developed problems since the incident with brother and falling off bike occurred? And that has to do with pain, rather than weakness? And there is no issue with pain in the right calf or possible new DVT there?

If that is all so, then it is very possible the problems really are a result of the two incidents and not some result of the DVT and hemorrhage. One good things is on the whole, kids tend to be very resilient and heal very well compared with older people.

The problem with x-rays when it comes to feet and micro fractures, is that those small fractures usually don't show up on x-ray. A bone scan can be more successful in this matter. Hopefully you do get to the physio soon. Because you're right, it may be metatarsalgia, however, it could also be microfracturing, or a number of other issues.

You're on the right track with having your son keep active and moving. Have him do so within pain tolerance. So not pushing pain. Check in with the doc again to let him/her know that the foot is still and issue. The doctor may pursue further testing.

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Originally Posted by violablue

You have all been through a lot! Hope you find things improving rapidly in the future.

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Thanks for the well wishes ...yes, you could say it hasn't been the best of summers! (but bearing in mind badly this episode could have turned, you can imagine that we're *extremely* relieved)

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Originally Posted by violablue

You have all been through a lot! Hope you find things improving rapidly in the future.

To double check, the DVT was in the left leg?? The right has developed problems since the incident with brother and falling off bike occurred? And that has to do with pain, rather than weakness? And there is no issue with pain in the right calf or possible new DVT there?

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No the the DVT clot was in his right leg groin area (& just to underline...his right leg was not impacted by the brain haemorrage) ...& it was this same leg that his brother fell onto (well his foot actually), then the same right leg that got hurt when he fell of his scooter, then the same leg that he started limping on after a fun swimming pool session (& walk in the park)...I'm of the opinion that his leg was so weak from the clot (when he wasn't able to walk properly for about 4 weeks), that when he came to start walking again the slighest incident caused major impact....but now I'm worried that all these setbacks are now going to start impacting his walking permanently. Even now, 3 weeks after the swimming (when he started limping for no apparent reason afterwards) he still continues to walk on his right foot outer edge with his big toe pointing up. (and his right leg calf muscle can't be massaged without him in a lot of pain)

Thanks for the heads up about a bone scan...something to pursue while we wait on physio!

Turning the foot out and lifting the toe could well be simple compensatory strategies for him not wanting to put this heal to the floor in dorsi-flexion i.e. a tight calf area and or a stuff ankle joint. You could go the the local chemist and buy some heal wedges for his shoes/trainers (if he wears them). I would think at least 5mm so you might buy a few and stack them up under the innersole. Slip them into his trainers to see if that allows him to land more evenly on the heels. It that works in the short term you can gradually reduce the height of the lifts as his muscle accommodates more to the stretch.

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Originally Posted by physiobob

Turning the foot out and lifting the toe could well be simple compensatory strategies for him not wanting to put this heal to the floor in dorsi-flexion i.e. a tight calf area and or a stuff ankle joint..

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But when I press the pad of his foot (metatarsal area...on the big toe side and in a line from the big toe pad to his heal), he's in agony -particularly near the big toe pad of his foot ...so I don't think him walking on his right footoutside edge (& lifting his big toe) is just him compensating for a tight calf area (though the tight calf area might be causing this to a degree)

Depends what came first. The toe might have been a symptom that came due to the tight calf. Chicken and egg. Once that is worked out all should normalize. In the short term keep him in more cushioned trainer type shoes. You can even cut out that area in the shoe insert if he needs some relief. There could also be some neural structures involved following the DVT and period of time off walking. Why can't you go for a one-off private paeds assessment while you are waiting for the other physio to come through?