Sudden, Painful Bumps on the Feet of a Child
An 8-year-old boy was seen in the ED for sudden, extreme tenderness of the soles of his feet. He now sees you, in primary care.
An 8-year-old boy presents with a 1-day history of red, painful lumps on the soles of his feet.
He is a healthy child; results of lab tests are normal; he doesn't walk in bare feet; lumps are painful to minimal pressure.
Erythematous papules/ nodules on the plantar surface; on the weight-bearing surfaces only.
Consider the sudden onset of this problem. What was Cy doing before his soles began to hurt?
The child had been playing hop-scotch in a tournament.
The girl next door also arrives with painful feet; she played hopscotch, too.
Young girl has similar painful nodules on the plantar surface of her feet.
Close-up of painful nodules on young girl's soles.
Differential diagnosis: Pressure urticaria, cellulitis, chilblains, cutaneous larval migrans, traumatic plantar urticaria, vibratory angioedema, eccrine hydradenitis, contact dermatitis.
Answer: traumatic plantar urticaria
Traumatic plantar urticaria characteristics: sudden onset, progressive with continued activity; spontaneous resolution with rest; confined to soles
A closer look at plantar eccrine hidradenitis and contact dermatitis
Plantar eccrine hidradenitis. Occlusive footwear may be contributory but not in all cases.
Contact dermatitis, in this case possibly from wearing new shoes.
An 8-year-old boy's mother takes him to the emergency department (ED) when he complains, suddenly, that the soles of his feet are extremely painful. He is an otherwise healthy active youngster. After laboratory tests are run, he is discharged from the ED with instructions to follow up with his primary care physician. See how the case unfolds, above. Do you recognize the lesions? What's in your differential diagnosis?
