Despite common thought, kids do get their fair share of foot pain and foot injuries. Most of the time, these conditions are relatively minor issues, but still do require medical attention as foot pain is never normal at any age group. However, there are a few situations in which urgent attention is required as the condition could be potentially very serious. This is the case when a child’s foot is swollen, warm, and possibly red.
The causes of foot swelling and warmth, essentially the hallmarks of inflammation, are many. It is a natural response by the body to start the healing process when the body has been injured. However, there are times in which swelling and warmth is not directly related to a specific injury, and develops due to more serious disease in the body.
The first of these diseases will be discussed today.
While uncommon, children are at risk for developing a specific type of bone infection. Called hematogenous osteomyelitis, this infection is somewhat unique to children. Bones in adults can become infected by bacteria directly exposed to bone through a skin wound or abscess next to or probing to a deep bone. Kids do not necessarily require this direct exposure, and can develop bone infection from bacteria present elsewhere in the body. These can include respiratory infections, infected insect or animal bites, infected boils, cuts, scrapes, and abrasions, puncture wounds, or other trauma. The bacteria then enters the blood stream, and travels to a remote bone, where it infects a specific part of the bone due to the richness of circulation in the growing bone. About half the kids that develop bone infection are pre-school aged, and many are male (possibly due to more risk-taking in males which may lead to injury). The large long bones of the thigh and upper arm are most commonly infected, but the smaller bones of the foot can also be infected as well.
The symptoms of this condition include pain, swelling, skin warmth, fever, and an inability to bear weight on the involved leg or foot, as well as joint stiffness and pain if the nearby joint tissue becomes inflamed. The most common bacteria causing this infection include staph aureus and strep species, although with puncture wounds pseudomonas is present and in kids with Sickle cell anemia, salmonella is common. Diagnosis of this conditions is somewhat trickier than in adults, and multiple types of images, including x-ray, bone scan, and MRI may be needed to make an accurate diagnosis, as well as bone and joint fluid cultures and blood work.
Treatment typically involves 4-8 weeks of antibiotics, either strong oral medications or intravenous medications.
The main problem with this condition lies in the fact that a delayed diagnosis can lead to significant bone disease in a child, and can lead to permanent deformity or joint disease as the infection destroys healthy bone tissue. A prompt diagnosis is key to a faster recovery and better long term outcome.
I will continue this discussion next week and discuss yet another serious condition that can cause swelling and warmth in the child’s foot.