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Correlates and predictors of paediatric leg pain: a case-control study
Angela Margaret Evans1, Trupti Berde2, Leila Karimi3
1Discipline of Podiatry, College of Science, Health, and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia. angela.evans@latrobe.edu.au.
Insights
Pediatric leg pains in children are often linked to increased joint mobility and ankle strength. This study defines subtypes of leg pain, finding specific factors predict each type.
Area of Science:
- Pediatric Orthopedics
- Rheumatology
- Clinical Pediatrics
Background:
- Pediatric leg pains, commonly termed 'growing pains', are prevalent in early childhood, causing sleep disruption and parental distress.
- Existing literature lacks defined subtypes and predictive factors for pediatric leg pains.
- Associations with factors like foot arches, strength, joint mobility, vitamin D, and iron are cited but not fully elucidated.
Purpose of the Study:
- To explore implicated factors (foot arches, foot strength, joint mobility, vitamin D, iron) in children experiencing leg pain.
- To define and differentiate leg pain subtypes: growing pains (GP), restless legs syndrome (RLS), and mixed (GP/RLS).
- To identify predictive factors for pediatric leg pains and their subtypes.
Main Methods:
- A case-controlled study design was employed in a primary care setting in Mumbai, India.
- Participants included 77 children aged 3-12 years (64 with leg pains, 13 controls).
- Data collected included blood assays (iron, vitamin D), pain questionnaires, Beighton score for joint mobility, foot arch assessment, foot strength tests, and anthropometrical measurements.
Main Results:
- Increased joint mobility and ankle dorsiflexion strength predicted leg pain across all groups.
- Specific subtypes were identified: GP predicted by increased ankle dorsiflexion strength; Mixed and RLS predicted by increased ankle dorsiflexion strength and pain questionnaire scores.
- High prevalence of hypovitaminosis D (87%) and anemia (13%) was observed. Increased body weight, waist girth, and BMI were associated with leg pain.
Conclusions:
- Increased ankle dorsiflexor strength and joint flexibility are significant predictors of pediatric leg pain.
- The study successfully defined and differentiated subtypes of pediatric leg pain (GP, RLS, Mixed).
- High rates of vitamin D deficiency and anemia warrant attention, alongside factors like obesity, in managing pediatric leg pains.
Abstract:
Paediatric leg pains, long described as 'growing pains', frequently present to clinicians, are prevalent in early childhood, disrupt sleep, and distress affected children and parents. There are many cited associations, but no defined leg pain sub-types, nor revealed predictive factors. We explored the implicated factors (viz. foot arches, foot strength, joint mobility, vitamin D, iron) in children with leg pain versus a control group. Leg pain sub-groups-growing pains (GP), restless legs (RLS), both (mixed)-are defined for the first time. A case controlled study design, in a primary care setting, Mumbai, India. A total of 77 children with leg pains (n = 64) and controls (n = 13), aged 3-12 years, identified by paediatricians, completed data collection. Blood assays for iron and vitamin D, pain, Beighton score, foot arch, foot strength and anthropometrical data were collected. All outcome measures were validated, with standardised protocols. Leg pain (all groups) was predicted by increased joint mobility and increased ankle dorsiflexion strength (β = 0.56, P < 0.05). GP sub-group was predicted by increased ankle dorsiflexion strength (β = - 0.06, P < 0.05). Mixed (GP/RLS) and RLS sub-groups were predicted by increased ankle dorsiflexion strength (β = 0.66, P < 0.05) and pain questionnaire (β = 0.11, P < 0.05). Hypovitaminosis D was detected in 87% of the sample, and anaemia in 13%. Increased strength of ankle dorsiflexors and joint flexibility were each found predictive for leg pain. Increased body weight, waist girth, and BMI were all associated with leg pain.
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