10 year old gymnast with worsening foot pain over 3 months


(uk)

Hello


I have a ten year old daughter who started having pain in the base of her foot 3 months ago, She is a gymnast and trains about 13 hours a week. The pain is just below her toes and all over her arch. The pain came on gradually with no history of injury it just seeems to happen with no warning.

She walks and holds herself quite floppy and at first we thought it was a problem with that or the fact that she has very bendable joints.

When this started she started to walk on the outside edge of her foot but could put weight on her whole foot when she needed to. The doctor told us she had tendonitis and that with a little rest it would heal. Her coach kept up her conditioning but stopped all weight bearing traning (ie tumbling beam etc.)

Over the next three months we have alternated ice and heat as the doctor advised, also we have seen a sports physio who gave her some exercises as she tends to roll her feet inwards as she walks which has caused her inner ankle bone to be very close to the floor (i hope you understand what i mean by that as it is hard to explain)

My daughter has been very good and despite the constant pain from her foot has done everything asked of her as she wants to get back in the gym.

This is only affecting the one foot is that normal for tendonitis?

Unfortunatly though the pain has got worse to the point that she will only walk on her heel. I was looking at this site and trying to find out which type of tendonitis she may have as all the ones i have seen describe heel pain and my daughter has no heel or ankle pain at all it is underneath the front part of her foot and around her arch only.

She has had other medical problems which are being investigated at the moment (I mention this in case it helps) she is asthmatic and has to have regular tablets to keep this under control, also she is very small and has had problems with chronic tiredness this past 6 months or so. We are investigaing this but are unsure of any connection tothe foot pain.

Her diet is extremely good althogh she does lose weight frequently but we give supplements to try to combat this. She understands the importance of hydration and takes a drink at regular intervals.

I was wondering if you had any advice about what type of tendonitis this could be and how long the heaing time is?

Also I was wandering what i should be doing to help her get back to normal. As a last note i have took her for an xray and their is definatly no fracture.



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Joshua Answers:

Hi there. Thanks for providing all those details right off.

I'll get to the foot in just a minute.

The first thing that jumps out at me is the tiredness and the weight loss. That's not normal for a 10 year old.

I'm going to have my Kerri from
www.Easy-Immune-Health.com
comment here. Your daughter definitely has something digestion related going on, gluten intolerant and leaky gut syndrome where she's not getting the nutrition from her food, or a parasite, or some such.

It's also a very safe bet that she's Vitamin D deficient, how much so is the question.

What kind of supplements do you give her to combat the weight loss?

Moving on to the foot...

Possibly related to the nutrition absorbtion, but probably not directly so.

It sounds like your is daughter hypermobile. Can she touch her thumb to her forearm? When she straightens her forearm does it hyperextend/go past straight?

If she has lax ligaments, and or has especially lax ligaments in her foot/feet, then it's not so much a wear and tear tissue damage kind of Tendonitis so much as a the structures aren't held firmly so get pulled apart and irritated/possibly injured kind of Tendonitis.

There is definitely a Process of Inflammation in place keeping things hurting.

And the Posterior Tibialis can be playing a role, not doing it's job correctly so the foot flattens out/the arch isn't held how it should be held. There's options.

1. Confirm for me whether she is hyper mobile or not.

2. How exactly have you been icing? Ice Pack for 20 minutes?

3. How much protein would you say she eats?

4. Does she walk on the side of her feet because it hurts? Does it just feel 'funny'?

5. How bad is the pain?

6. Can she exercise pain free once she gets warmed up, and then it hurts later?


Answer those questions, and we'll go from there.



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Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Sep 22, 2009
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PART 2 - In reply to your questions - 10 year old gymnast with worsening foot pain over 3 months
by: Anonymous

Hello

1. She has multi vitamins every day and pro biotic drinks daily to try to help her digestion and tiredness

2. She is definitely hyper mobile she can put her thumb to her wrist with no gap and then keep going; if she sits on the floor and raises her legs from the knee she can bring the complete lower section off of the floor so her ankles and calves are not touching anything. Also she can do things like twist her arm fully round and put her hand down flat while twisted. Her elbows look as though they are bending the wrong way when she straightens her arms fully

3. Icing has been an ice pack for 10 minutes three times a day she struggles to have it on any longer as she says she gets a burning sensation in her foot. We have also used ibuprofen gel.

4. I am not sure how much protein she eats but to give you an idea she eats breakfast of cereal and toast in the morning a school dinner and then meat and vegetables at night. She has average portions for her age and eats nearly everything on her plate.

5. She walks on the side of her foot because it hurts and it is the only way she can relieve the pain although recently she will only walk on the heel of her foot as this gives less pain

6. The pain seems to be pretty bad if we ask her to walk properly on the full foot she is crying within a couple of steps and has to revert back to heel walking.

The pain is constant as soon as she puts any pressure on the foot even if she is warmed up the pain is always there, however if she is not walking on it will ache rather than hurt. She does not seem to have any fully pain free time since this started

Hope these answers help.







Sep 22, 2009
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PART 3 - 10 year old gymnast with worsening foot pain over 3 months
by: The Tendonitis Expert

Joshua Comments:

Great answers, thanks.

1. Kerri will comment on digestive stuff.


2. Ok, so she's high on the hypbermobile scale. On the upside, she's able to do some gymnastic stuff with ease.

On the downside, her body can go way farther than may be 'good' for her, in the sense that she has less structural strength holding her bones together.


3. Check out my How To Reduce Inflammation page.

Icing as doctors describe just isn't effective. Do the ice dip as much as humanly possible for at least three days, that should drop overall pain, and then start ice massage on the specific spot in the foot that's hurting.

I predict it's at a joint somewhere there in the foot, such that when she steps, either the joint is getting pulled too far apart, or the bones are pushing on each other (and bone bruises HURT bad, and if every step is irritating that bone bruise....)

The problem with really hypermobile is that not only can structures be pulled apart too much, there is nothing holding them apart, in the sense that bones can rub on each other, and rub in bad ways.


4. In general, definitely not enough protein for her activity level. She might be getting enough calories, but most of what protein she is getting is getting burnt as fuel, and less is available for replacing normal cell death/replacement, and then building muscle and stronger tissue with whatever is less.

In my experience and observation, little athletes are notoriously undernourished. Not obviously so, but it shows in little things like injury, energy, attention, etc.

Youth will go a long way, but will only take them so far. They're little race cars, and high octane fuel and top of the line oil will keep them going better.

And if she has leaky gut from being gluten intolerant, or depending on the type of parasite or bacterial overgrowth, she's not getting all the nutrients from her food.

More protein. Talk with Kerri.


(CONTINUED IN PART 4)



Sep 22, 2009
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PART 4 - 10 year old gymnast with worsening foot pain over 3 months
by: The Tendonitis Expert

(CONTINUED FROM PART 3)

5. See above. And, as far as keeping her out of pain in the future, there's likely a trip to a really good podiatrist in your future. Assuming that her foot bones are too hypermobile, she may need just the right orthotic, or foor wrap, or some such, to keep the joint from moving too much or grinding, depending on what is happening.


6. She has acute inflammation right now.

First things first. Ice like her life depends on it. Her athletic career certainly does. The more dips in a day, the merrier.

A short cane or crutch just to keep weight off the foot is a good thing. I don't normally advise rest at all, but -if- she's got a bone bruise, it is useful to remove all irritation to it.

This is good in the short term while you are ice dipping and then dipping and ice massaging.

I obviously haven't seen her in person, but it's safe to say that this may be a critical juncture for her.

Her pain is unlikely to get better if she just modifies her workouts this season. It likely to return if she takes a year off and then gets back into it.

Might as well learn how to deal with it, and injury in general, now. Icing is one of the best tools you will have, and if she's going to be a competitive gymnast....well, she's going to have injury here and there.

I'm right her to help you through it.



Oct 18, 2009
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Sorry to take so long to answer...
by: Kerri Knox, RN- The Immune Queen!

Hi Gymnast mom,

OK. I've been reading your conversation with Joshua, and I'm SO sorry to have taken so long to get back to you.

I don't think that I'll address her pain, because I think that it is likely a symptom of some other issues that I will go into.


FIRST and most importantly, I REALLY think that you should have her checked for Celiac Disease. This is simply a blood test that your doctor can do. Unfortunately, it's not very accurate, but take a look at my page on Gluten Sensitivity here. The fact that she is small and that she tends to lose weight easily, and that she's having chronic pain leads me to believe that she is PROBABLY gluten sensitive, if not full blown celiac disease.

If you have anyone in the family with celiac disease, then there is almost no doubt anymore and you should DEFINITELY try her on a gluten free diet for two months to see if some of her symptoms clear up.


SECOND: I would really push her doctors to check her Vitamin D Level, as Vitamin D deficiency is RAMPANT, even in teenagers, and some of these issues (pain and fatigue) COULD very likely be due to vitamin D deficiency.

THIRD: It's just not NORMAL for teenagers to be tired! So, I just really feel that something is NUTRITIONALLY going on with her. You say that she eats like everyone else, but most everyone eats TERRIBLE and so it's likely she's not meeting her nutritional needs if she is tired.


I recommend that you guys take a look at my Bone Broth recipe and start making a habit of taking bone broth on a regular basis, and if she is eating ANY processed foods, sugar, sodas, juices to cut out all of those.

Your description of her diet says that she probably eats a LOT of processed foods, and while many teenagers thrive on that, your daughter may just not be able to and will need to keep her diet especially nourishing.


I have LOTS more info that I could give if you are interested.


Kerri Knox RN Immune Health Queen

Kerri Knox, RN- The Immune Health Queen
Functional Medicine Practitioner
Easy Immune Health.com


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