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Foot and ankle

Henoch-Schönlein Purpura (HSP), or IgA Vasculitis, in Children: A Guide for Parents

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Henoch-Schönlein Purpura (HSP), now known as IgA vasculitis, is a type of inflammatory condition known as vasculitis, that affects the small blood vessels in the skin, joints, intestines, and kidneys. It is one of the most common types of vasculitis in children and typically occurs between the ages of 2 and 11 years old. While the exact cause of HSP is unknown, it is believed to be related to an abnormal immune system response, often triggered by a preceding infection.

What symptoms do you get?

Symptoms of HSP can vary but often include:

  • Purpura: Small, raised purple or red spots on the skin, typically on the legs and buttocks, which may be painful or itchy.
  • Joint pain and swelling, particularly in the knees and ankles.
  • Abdominal pain or cramping.
  • Nausea, vomiting, or bloody stools.
  • Kidney involvement, which may lead to blood or protein in the urine, decreased urine output, or high blood pressure.

It’s essential to seek medical advice if your child develops any of these symptoms, especially if they occur suddenly or worsen over time.

How is it diagnosed?

Diagnosing HSP in children usually involves a combination of a physical examination, medical history, and blood and urine tests. Blood tests are done to check for signs of inflammation and to assess kidney function, while urine is tested for blood and protein. Your child’s blood pressure will also be taken.

What is the treatment?

In most cases, HSP resolves on its own within a few weeks to months without specific treatment. However, symptomatic relief may be provided with over-the-counter pain relievers such as paracetamol to alleviate joint pain and discomfort. It’s essential to follow your healthcare provider’s advice closely and attend regular follow-up appointments to monitor your child’s progress as about half of children with HSP will have a further episode. Typically, your child will be followed up at regular intervals for one year.

Rarely, in more severe cases your child may require additional treatments such as medicines to reduce inflammation and protect organ function.

Most cases of HSP will be monitored and resolve without long-term complications. If you have any concerns about your child’s health or if their symptoms are severe or worsening, seek medical advice promptly.

Minor Injuries of the Foot

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What is a metatarsal fracture?

The metatarsals are the bones in the foot that attach the toes to the ankle. A fracture is the same as a cracked or broken bone. This will be seen on an x-ray. These are minor injuries that will make a full recovery.

What to expect

  • Your child will have some pain. It should be mild and settle over the next few days, but it may take 2 – 6 weeks for the pain to fully disappear.
  • There may be bruising and swelling which is normal and should improve during the first week.
  • It can take 4 – 6 weeks before the bone has fully healed. If you were given a supportive boot, you can stop using this after 2 weeks when there is little pain on walking. You should then wear a cushioned, supportive shoe.

Treatment

  • These injuries heal well with time. They do not need a cast or need to visit a bone specialist. Your child may be given a rigid boot or shoe that can support the injured foot while it is healing, or a well-cushioned supportive shoe does the same job.
  • Gentle movement and body weight can be taken while wearing the boot. This works better than keeping it completely still. Moving the foot gently, even if it causes a little discomfort, will not cause more damage.
  • Keep the foot up on a pillow when sitting. This will reduce swelling.
  • Improve movement by flexing the ankle up and down. Try tracing circles with the big toe in the air.
  • Use paracetamol or Ibuprofen as a painkiller. Please always give medication as indicated on the label.

Returning to sport

  • Return to ‘no-impact’ sport like swimming gradually once the pain has improved, usually 2 – 4 weeks.
  • Once your child is pain-free and able to run without causing the pain to return, they can return to their normal activities. This is usually around 4 weeks.

If your child’s pain is not improving or they are still experiencing high levels of pain after 4 weeks, please contact the Emergency Department on 0131 312 0007 / 0131 312 0008 and ask for a face-to-face review clinic appointment.

Plantar fasciopathy

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Image of a foot being held by the big toe with the heel part of the foot circled in black

What is plantar fasciopathy?

Plantar fasciopathy is when there are inflammatory or structural changes to the plantar fascia ligament in your heel resulting in pain. This is also described as plantar heel pain.

What are the causes?

There are several proposed risk factors for plantar fasciopathy including:

  • Weight-bearing activity (e.g. standing)
  • Tight calf muscles
  • Obesity
  • Foot shape and/or the way your foot moves
  • Existing medical conditions (e.g. Diabetes)

What are the symptoms?

  • Pain in the affected heel which may extend into the arch of your foot
  • Pain made worse by weight-bearing activity (e.g. standing)
  • Intense pain during your first few steps after a period of inactivity (particularly in the morning when getting out of bed)
  • Tenderness over your heel

How is it diagnosed?

An appropriate healthcare professional will discuss your symptoms and enquire about your general health. A physical examination of your foot and ankle will be carried out to assess your movement, response to particular tests and level of pain. This condition is diagnosed by clinical examination. In rare cases diagnostic imaging may be required.

Toddler’s fracture

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A Toddler’s fracture is a small break, often referred to as a ‘hair-line fracture’, to the shin bone (tibia), the large bone in the lower part of the leg. This type of injury is typically caused by a minor fall or a simple twisting of the leg and is very common in children under 3 years of age.

Hearing us say your child has a ‘fracture’ sounds serious. The good news is, that your child has a minor injury – the bones are stable and held in the right place, no procedures are needed, and your child will make a full recovery.

illustration of a child's bone showing a thin crack on the bone (toddler's fracture)

What tests will be done?

Your child may have an x-ray. The nurse practitioner or doctor will make this decision based on the history of the injury, their examination, and the age of your child. Toddler’s fractures don’t always show up on the first x-ray because they are so small.

What is the treatment?

The nurse practitioner or doctor will discuss a treatment plan with you as it is not always necessary to immobilise the leg with a plaster cast or moonboot. Your child may only require simple painkillers such as Paracetamol (calpol) and Ibuprofen, and rest.

What should we do when we get home?

We recommend that you give your child regular paracetamol (calpol) and/or ibuprofen for the first 48 hours. Your child will adapt to having sore leg and will change their play for this. This means they may go back to crawling or may just want to be carried. If they want to walk that is absolutely fine.

If you feel that your child is too sore despite having regular painkillers, please bring them to the Emergency Department so we can review them.

Follow-up

It may be several weeks before your child walks normally again. They often walk with a limp, or their foot turned out initially but this will improve.

If your child is not walking normally 4 weeks after the injury, please contact the Emergency Department on 0131 312 0007 or 0131 312 0008 and ask for a face-to-face review clinic appointment.

Sever’s Disease

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What Is Sever’s Disease?

Sever’s Disease is a common cause of foot and heel pain in children and adolescents. It is not yet known exactly what causes Sever’s but it is thought to be caused by repeated stress around where your calf muscles attach to the heel bone.

This can cause a traction-type injury where the local bone and soft tissues can become inflamed and sore, especially during certain foot and ankle movements and activities.

Pain is most commonly felt around the back of your heel, sometimes up into your calf a little and also sometimes down into the sole of your foot.

Who can get Sever’s?

  • Children and adolescents going through a large growth spurt.
  • Children aged 8-15 with a greater incidence in boys.
  • Children and adolescents who participate in repeated high-intensity activity with higher impact such as hopping, jumping and change of direction.
  • Higher incidence in athletes who specialise in only one sport early.

What are the most common symptoms?

  • Heel pain either during or after participation in sports which typically eases with rest.
  • Tenderness around your heel bone.
  • Reduced calf strength.
  • Tightness of your leg muscles.

These symptoms usually come on gradually and can appear in one or both of your feet.

Contact NHS Lothian