Foot Swelling and Warmth In Kids: Part One

foot pain in kids

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.

What You Should Do If Your Toenail Rips Off In An Injury

toe injury

Lifting injuries to toe nails, especially to big toenails, are not uncommon.  However, this injury often does not receive the proper medical care it requires due to the perception that the injury is minor.  While true in many cases, there are times in which this injury can lead to significant complications, and in general many people treat this injury incorrectly from the start.

The toenail is a loosely attached piece of hard compressed tissue that grows from cells located behind the cuticle, under the skin.  The nail cannot stay ‘glued’ down onto the skin below it because it has to move forward as it slowly grows.  For this reason, any injury that catches under the edge of the nail, or smashes down on the nail causing bleeding under the nail can cause lifting of the nail itself, sometimes causing it to tear off completely (or at least close to it).  The natural response by most people is to try and reattach the nail back on the skin through tape, a dressing, or even glue.  Unfortunately, in certain circumstances, this can lead to various problems.  When an injury is strong enough to rip the nail off, it may be strong enough to cause damage to the bone at the tip of the toe, which is near where the nail grows from in the first place.  Toe fractures in and of themselves are generally not serious, but fractures associated with tearing or bleeding of the skin surface underneath the nail can be if the small pieces of bone are exposed to open air.  This can lead to bone infection, which is difficult to treat in the toes and can lead to a partial toe amputation.  This is especially true in diabetics or those with poorly functioning immune systems.

When one has experienced a toenail injury that has caused the nail to lift up or off, it is important to see a physician (preferably a podiatrist) for careful evaluation of the skin under the lifted nail, as well as possible x-rays if a fracture is suspected.  Sometimes the nail must be completely removed to drain blood, inspect the nail bed for bone fragments or tissue tears, or to prevent bacteria and fungus from growing underneath it and causing an infection that may be difficult to treat.  The nail will grow back, although it should be understood that any injury strong enough to lift the nail has likely also injured the nail root, and the nail growth that follows will likely be different forever.  The nail may now grow thick, malformed, or curved inward.  If bone fragments are noted, the area must be medically cleansed, antibiotics must be taken, and proper wound care must be performed under the direction of a physician in order for the area to heal properly and without infection.

One exception to this advice is when athletes like runners have toenails fall off due to bruising under the nail from running.  This is common, is related mainly due to continued toe pressure in shoes while running, and is rarely associated with more traumatic injuries like fractures.