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Paediatric Swollen COLD foot

Discussion in 'General Issues and Discussion Forum' started by erinbeeler, Sep 16, 2010.

  1. erinbeeler

    erinbeeler Member

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    Hello There,
    I am wondering if anyone could shed some light on a patient I had in clinic today.

    11 year old female, presented with a gradual onset (1-2 days) swollen right foot. The swelling is predominantly dorsal. No recent history of trauma (foot was lightly 'stood on' 6 weeks prior). Swelling is mostly dorsal across the tarso-met area. Malleoli's not swollen. Pain on palpation of styloid, and met heads.
    Vibrations did not produce pain. The most notable thing (that really threw me) was that the foot was cold. Markedly. Not blue/white etc (ie normal colour, same as other side) But much colder from the lower 1/3 of the leg right through to the toes. The unaffected side was a normal temperature. Sorry I do not have dermatemp, but it was markedly colder.

    The patient is unable to weight bear, and is getting about on crutches. Her GP and the emergency room staff at the hospital (where she went to first) are at a loss to explain what is happening.

    Any thoughts?

    Thanks alot.
  2. Mr.T

    Mr.T Member

    Have any scans been performed while at hospital and if so are you aware of results eg x ray??

    Have seen a case of chronic regional pain syndrome with similar symptoms, however this was after severe trauma and your case sounds more acute. Interested to hear if scans have been perfomed to investigate more thoroughly...
  3. stephenfinney

    stephenfinney Welcome New Poster

    Description madates for ruling out CRPS ASAP early detection and treatment critical to good outcome
  4. erinbeeler

    erinbeeler Member

    Thanks for your replies - Re: the imaging. Sorry I did not mention it above, but yes XRays were taken (multiple) of both the Right and (for comparisons sake) the Left. These were ordered by her GP. There was nothing remarkable to report in these. No further testing has been done.
    Thank you for your advice re: CRPS. I shall phone her GP now and suggest this - he may have been thinking similar things -

    Thanks so much, if I learn anything new regarding this case I shall post it immediately.

  5. marhar

    marhar Member

    I would be thinking differential diagonsis - fractures and she should go through ED at local hospital or Campartment sydrome. Leg goes white. Vascular studies.Though at 1-2 days she would have got necrosis of muscles and in severe pain.
  6. erinbeeler

    erinbeeler Member

    How is this for different....

    At the time of the origianl post I referred her back to her GP for blood tests (general).
    Apparently the blood tests showed "kidney infection, low iron and low vit D levels" (this is according to her father)
    She has been prescribed medication, and as of yesturday is able to weight bear on this foot, and the swelling has decreased. This is the observation of her father. He was unable to tell me about the temperature.

    I will continue to check in on her, but isnt this interesting??
    Im still a bit stumped as to why it had this effect on one foot.

    Thanks for all your help so far, if anything further develops I shall post again.

  7. marhar

    marhar Member

    good to see resolution. Sounds like she had an infection and antibiotics for kidney fixed foot
  8. Mr.T

    Mr.T Member

    Interesting case, glad to hear all is well, however curious as to why a kidney infection, low vit d and iron would cause localized unilateral discomfort???

    I realise the implications all of these issues have on the body but it still seems a little strange they could all cause such a local unilateral problem. Could resolution have been coincidental??

    Conspiracy theory maybe, but it's sometimes these strange cases we can learn the most from...

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