Persistent Bruising and Heel Pain in Adolescents: A Guide

I'm sorry, but I cannot assist with that?

Hello Dr.
Lin: I would like to ask about my lower leg.
Three months ago, I experienced a trauma to the front bone of my lower leg, which resulted in bruising.
However, even after more than three months, the bruising has not resolved.
Could you please explain why this might be happening? Is it possible that it will remain this way? I have tried self-massage and heat therapy multiple times.
Should I consider getting any specific examinations, and which specialty would be most appropriate?
Additionally, my thirteen-year-old cousin is experiencing heel pain without any history of injury.
The pain seems to move slightly around the heel area but is mostly localized there.
This has been ongoing for over ten days, and while it does not hurt when walking, it does hurt when pressed.
Thank you!

beeth, 20~29 year old female. Ask Date: 2001/04/26

Dr. Lin Mingxing reply Family Medicine

Hello, it is recommended that you visit an orthopedic specialist for further examination.
Based on your description, you sustained an injury from a collision three months ago; it is unclear whether you consulted an orthopedic doctor at that time.
It is important to rule out any fractures.
As for your cousin's symptoms, they appear to be related to a neuromuscular issue.
It is advisable for you to seek further diagnosis from an orthopedic physician.

Reply Date: 2001/04/26

More Info

Persistent bruising and heel pain in adolescents can be concerning symptoms that warrant further investigation. Let's break down the issues you mentioned regarding the ongoing bruising in your lower leg and your cousin's heel pain.

Persistent Bruising
Bruising that lasts for an extended period, such as three months, can be attributed to several factors. When you experience a bruise, it typically goes through a healing process where the body reabsorbs the blood that has leaked into the surrounding tissues. However, if bruising persists, it may indicate an underlying issue. Here are some potential causes:
1. Vascular Issues: Conditions affecting blood vessels, such as vasculitis or other vascular disorders, can lead to prolonged bruising. These conditions may require evaluation by a specialist, such as a hematologist or a vascular surgeon.

2. Platelet or Coagulation Disorders: If your body has issues with blood clotting, such as thrombocytopenia (low platelet count) or other clotting factor deficiencies, this could lead to easy bruising. A hematologist would be the appropriate specialist to consult for these concerns.

3. Injury and Healing: Sometimes, the initial injury may have caused damage to deeper tissues or blood vessels that take longer to heal. If you have been massaging and applying heat, it may help with circulation but could also irritate the area if done excessively.

4. Nutritional Deficiencies: Deficiencies in vitamins such as Vitamin C (scurvy) or Vitamin K can affect the body's ability to heal and clot properly, leading to prolonged bruising.

Given these possibilities, it would be advisable to consult a healthcare provider who can perform a thorough examination and possibly order blood tests to evaluate your clotting factors and platelet levels.

Heel Pain in Adolescents
As for your cousin's heel pain, especially if it is localized and occurs without a clear injury, there are several common conditions that could explain this symptom:
1. Sever's Disease: This is a common cause of heel pain in growing adolescents, particularly those who are active in sports. It is an inflammation of the growth plate in the heel and is often exacerbated by physical activity. The pain typically occurs during activity and may improve with rest.

2. Plantar Fasciitis: Although more common in adults, adolescents can also experience heel pain due to inflammation of the plantar fascia, the tissue that runs along the bottom of the foot. This condition is often associated with overuse or improper footwear.

3. Tendinitis: Inflammation of the Achilles tendon can also cause pain in the heel area, especially if there is tightness or overuse.

4. Stress Fractures: Although less common, stress fractures in the heel or surrounding bones can occur, particularly in active adolescents. These typically require imaging studies to diagnose.

Since your cousin's pain has persisted for over ten days, it would be wise for him to see a healthcare provider, preferably a pediatrician or an orthopedic specialist. They can conduct a physical examination and may recommend imaging studies, such as X-rays, to rule out any fractures or other structural issues.

Conclusion
In summary, persistent bruising and heel pain in adolescents can stem from various underlying conditions. It is crucial to seek medical advice to ensure proper diagnosis and treatment. For the bruising, a hematologist or vascular specialist may be appropriate, while an orthopedic specialist or pediatrician would be suitable for the heel pain. Early intervention can help prevent further complications and provide relief from symptoms.

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