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Sunday, April 5, 2015

Ollier's Disease and Calcaneal Apophysitis: Email Advice

From Wikipedia:
Ollier disease is a rare nonhereditary sporadic disorder where intraosseous benign cartilaginous tumors (enchondroma) develop close to growth plate cartilage. Prevalence is estimated at around 1 in 100,000. Normally, the disease consists of multiple enchondromas which usually develop in childhood. The growth of these enchondromas usually stops after skeletal maturation. The affected extremity is shortened (asymmetric dwarfism) and sometimes bowed due to epiphyseal fusion anomalies. Persons with Ollier disease are prone to breaking bones and normally have swollen, aching limbs.

Hi Dr. Blake,

I am truly at a loss for my son’s pain in his rt. Foot.  The pain is in his heel and it just isn’t getting any better.  A little history… my son has Ollier’s Disease and has had two surgeries on his Rt. Leg.  1st surgery was May 2011 femur fracture, rod placement.  2nd surgery was leg lengthening and corrective alignment of knee.  The leg lengthening wasn’t exactly a success as he was growing bone too quickly which forced us to double up on the amount of turns each day to avoid the bone from growing together.  This caused him to have severe nerve pain, that lasted about a year.  He was taking Neurontin to control this pain.  He also ended up with stress fractures once he could walk but it was the nerve pain in his foot that was the worst.  He ended up still being short in that leg and continues to be about an inch short.  During this time, his rt. Foot was 2 ½ sizes smaller than his left foot.  Today he is only about one size different. Rt. Shoe is a 3 left shoe is a 4.  He also has an internal lift in his rt shoe.  He still has trouble going down stairs, he takes them one at a time vs. a continue flow.  He recently had to have surgery on his left arm they actually did a salvage surgery to save his left forearm from amputation creating a one bone forearm in Sept. 2014. He again had nerve pain and was put on Neurontin which he is still taking.  

On March 15th he was playing with friends being very active (which he really hasn’t been able to do) for about 4 hours.  He ended up coming in basically crawling because he couldn’t walk and started complaining that his heel really hurt with some pain on the top of his foot but mostly just his heel. There was no swelling, no redness, but it hurt to touch it and move it.  They were doing a lot of jumping as they were trying to make a big look out nest on top of a very large snow pile.  We took him to our local urgent care, they took x-rays and said they looked ok that it was most likely a deep, deep bruise and to stay off of it and rest it. 

  Three days went by and he wasn’t getting a lot of relief from the ibuprofen he was taking around the clock, icing it helped somewhat, but he was still pretty miserable.  I ended up taking him to Children’s in Boston where he is followed by two ortho doctors. He saw a Dr. on call, they took more xrays, and placed him in a boot.  He couldn’t stand the boot, he said it made the pain worse, he tried to wear it for short periods of time but it just wasn’t working.  The pain was still the same and not getting any better.  We went back to Children’s and this time they put him in a cast.  The cast was better but it still didn’t provide enough relief.  He was asking for pain medicine around the clock so I started thinking that it might be more nerve related.  We went back to Children’s yesterday and they took off the cast.  When they took the cast off he was in a ton of pain and said it felt better in the cast.  UGH!!!!   So, they ended up making a bi-valve cast so he can remove it and I can massage his foot.  He is absolutely miserable still, he keeps saying he just doesn’t know what to do and frankly neither do I.  We are going to be seen by the pain clinic at Children’s tomorrow and I’m hoping that you can give me your thoughts based on the xrays and my description.  Sometimes another set of eyes can bring something else to light.  This pain wakes him up at night, he has trouble falling asleep, he just wants to be a normal boy!!! 

PLEASE, PLEASE, PLEASE share your insight with me.  I would be beyond grateful for any advice and can be reached by phone or email.

Thank you & Warmest Regards,

Dr Blake's comment: Thank you so very much for the email. The heel looks normal on xray, but the pain from calcaneal apophysitis (yes, a normal injury) can be intense. The treatment is ice soaking 20 minutes (heel in the ice bucket only, not the entire foot) 3-4 times a day since the pain is primarily inflammatory. These growth plates stay open in boys until 14, so he could have a few episodes. You ice 3 days longer than you need to with each episode. After 5 days of icing, let me know what is happening. You should be aware of Calmare Pain Therapy for nerve pain. Go on their website, I am not sure if there are age restrictions, but it can be used on any part of the body, and it non-invasive. Hope this helps some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.