Evans proposed definition of growing pains: Inclusion and exclusion criteria

Pain factors	Inclusion criteria	Exclusion criteria
Nature of pain	Intermittent, some pain-free days and nights	Persistent, increasing intensity
Unilateral or bilateral	Bilateral	Unilateral
Location of pain	Anterior thigh, calf, behind knee – in muscles	Joint pain (exclusive)
Onset of pain	Late afternoon, evening, nocturnal	Pain still present next morning
Duration	At least 3 months
Physical examination	Normal*	Swelling, erythema, tenderness; local trauma or infection; reduced joint range of motion; limping
Laboratory tests	Normal	Objective findings – inflammatory indices, imaging abnormalities (radiographs, bone scan, MRI)
Limitation of activity	None	Reduced physical activity

MRI: magnetic resonance imaging.

* Hypermobility, pes planus, genu valgus do not exclude growing pains.

From: Evans AM. Growing pains: Contemporary knowledge and recommended practice. J Foot Ankle Res 2008; 1:4. Copyright © 2008 The Author. https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-1-4 (Accessed on June 14, 2023). Adapted under the terms of the Creative Commons Attribution License 2.0.

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