pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Chronic Leg Cramps in Children

[A mother wonders if there is a “second opinion” somewhere to help with her daughters nightly leg cramps which her current doctor doesn’t seem to see as a significant problem.]

My daughter has had chronic leg cramps since she was 3 years old; she is now almost 10. The pain is most severe at night, but she complains of leg cramps during the day as well. She was born with ASD and when she was 4, she had a septal occluder implanted in her heart to close the hole – the surgery was very successful. Although I have mentioned the cramps to her pediatrician on every visit, she does not feel there is an issue. I however, have seen my daughter thrash, kick, scream and moan almost every night for the past 5 years. Most of the time she doesn’t even wake up, but she doesn’t get restful sleep either. I feel that I need to take her to see someone who will address this issue and take a closer look. Can you tell me what kind of specialist I should take her to see? Cara S.

Thanks for looking at the web site. I’m assuming you’ve already seen the other articles about leg pain in children. Your having seen a physician already, who assumingly has performed a thorough physical exam, does make writing a response more difficult because I don’t have the same advantage.

There are a couple or three issues: First, the term “pediatrician” now-days seems to be used (like the term Levi’s or Kleenex) as a generic term for “the person who sees my children”, regardless of their training, expertise or certification. The term “Pediatrician” should only be used referencing a medical doctor (not assistant or practioner) who has completed a residency in Pediatric and Adolescent Medicine (not family or general medicine) and has passed the national board certification exams. So, I’m not sure what you mean by it, or what level of expectation we should have about her thoroughness or skill level. That makes a difference for the next issue.

Second, the few sentences of history you have given in your question does, definitely fit into that of “pes valgo planus” (PVP – flat feet); BUT, that condition is easily spotted in a thorough physical examination. So, one should expect that a physician who has performed a physical exam of the child’s feet and gait would be in a position to tell you about it. Of course, even the best of doctors will, on occasion, overlook something they are not looking for, although if you’ve specifically asked for a look-see of the feet – it’s pretty hard to miss. There is a “loss” of the normal arch and the child looks like they are walking on the inside of their feet (i.e. there seems to be an inversion at the ankles). Activities of childhood, especially prolonged standing, causes overuse of the muscles trying to keep the ankles from falling inward so they eventually can ache and cramp. The feet tire easily and ache so the child often comes in from play or learns to avoid certain activities. And the cramps seem to heighten at night. It is most common for children who have learned to live with the discomfort to not even tell their parents or doctors about it.

Third, you didn’t have room in your short question to describe things you have tried or things that have helped; but, obviously shoes with GOOD arch supports (if you can find such things these days) are a PVP sufferers favorite kind of shoe. When they first came out, “tennis shoes” had great arch support – now days, don’t count on it. Cowboy/cowgirl boots are about the only kind of shoe that I know which is fairly consistent and often helps the problem dramatically.

Of course, there are other reasons for restless legs at night in children and even for aches and cramps, it’s just that the symptoms you describe are so common that this would be most physicians first choice. If you are already seeing a physician who understands the issue and has specifically looked for it on physical examination then they should be able to direct you to the next course of action.

A “second opinion” could be covered either by specialists in orthopedics or podiatry – however, you can probably assume that not all orthopedists deal with “simple things” of the feet (surgery is their main endeavor which is rarely, ever needed in this problem). Some podiatrists have the same issue; namely, focusing on surger. Additionally, because the main treatment modality is an orthotic to correct the arch imbalance, and because there can be a huge profit margin in making them, one needs to be a very careful consumer.

Before spending money on orthotics it’s really nice to at least have a physical examination finding of PVP. Then, the next step might be to try shoes/boots with substantial arches. If they stop the problem, fine; if they at least help, you at least know you are on the right path. I’ve seen lots of ineffective, but expensive, orthotics purchased by parents. In my experience the kinds that actually work best are NOT flat, hard plastic. On the other hand they are NOT the kind you can get at department stores which are pliable and not much different than those found in tennis shoes. They need to be firm, rubber-like inserts that bend but not give too much. They need to have an actual arch that you can see, and probably be uncomfortable to wear AT FIRST, so require some getting used to. You should see at least some benefit in days and once they’ve gotten used to them should have no pain or cramping.

Google “theta orthotics” and at least read their specifications for orthotics – then, if a trial of boots or your doctor’s exam points you in that direction, you’ll have something to compare with.

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