Foot Swelling and Warmth in Kids: Part 2

foot swelling in kids

Continuing on from my last post, I would like to discuss another serious condition that can cause swelling and warmth in a child’s foot.

There are a group of diseases in the body in which the immune system, the body’s defense force, is involved in the destruction of normal tissue.  Called autoimmune diseases, the main mechanism in these conditions is the active damage of normal body tissue by an immune system run amuck.  Joint tissue can be affected by some of these conditions, and a common disease that is a part of this group of illnesses is called rheumatoid arthritis.  When this condition is seen in children, it is called juvenile rheumatoid arthritis (JRA).

JRA can start as young as 6 months of age, and usually begins before the age of 16.  It can involve many joints in the body, a smaller group of joints, or only a few.  The initial symptoms can include a swollen joint, a new rash, a spiking fever, or simply limping.  As the condition evolves, the joints may become red, warm, swollen, stiff, and the child may begin to limp or refuse to participate in activities.  More wide-spread cases can result in the child looking sick and pale, with high fevers and a rash that comes and goes with the fever.  Eye problems can also develop, that may or may not have symptoms.

The diagnosis of JRA can be made through multiple means, including blood tests, organ swelling, x-rays, and joint fluid analysis.

In the foot, rheumatoid arthritis of any variety can result in devastating deformity and joint destruction over time.  If the immune reaction against joint tissue is not controlled, eventually the joints can become worn and deformed.  There can be a slower rate of growth, and a child in chronic pain from this condition can have poor activity desire and poor school performance.

There are medicines that treat JRA just like the treatment of adult rheumatoid arthritis.  These vary per symptom severity, and many milder cases of JRA actually can go into remission for many years without any  chronic joint changes.

If your child develops joint pain and swelling, especially if a fever and/or rash is present and several joints are inflamed, it is important to have them evaluated for potential causes, which may include juvenile rheumatoid arthritis.

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.