Approach to the Problem
Often resulting from stressors placed on them by normal weight-bearing activities and the restrictive setting of everyday footwear, the feet are prone to dermatologic conditions. Developing within the enclosed environment of a warm and moist shoe, a rash can easily spread or worsen. For example, allergic dermatitis on an excoriated toe can evolve readily into an extensive foot cellulitis. A foot lump, whether related to infection or an underlying bony abnormality, may continue to grow, potentially compromise normal foot dynamics, and readily recur if not properly diagnosed and treated. Therefore, a good understanding of common pediatric foot ailments is important.
Key Points in the History
• Origin (between toes or overlying pressure points), natural course (timing or spread from a specific focus), and symptomatology (itching, burning, pain, redness, or swelling) may aid in differentiation of a foot rash or lump as reactive or infectious (dyshidrotic eczema vs tinea pedis; callus vs plantar wart).
• Seasonality may be an important clue, with tinea pedis and dyshidrotic eczema more common in the warm, summer months, and juvenile plantar dermatosis more common during colder months.
• A correlation with new or overly restrictive footwear may support the diagnosis of a corn or callus.
• Communal bathing has been associated with infections, including tinea pedis and plantar warts.
• Epidemiology may also provide clues: infantile acropustulosis occurs between birth and 2 years, juvenile plantar dermatosis occurs more commonly among prepubertal children, and tinea pedis and plantar warts are present in older children and adolescents.
Key Points in the Physical Examination
• Delineation of dermatitis from an infectious rash may be based on appearance and distribution (warmth, tenderness, vesiculation, or crusting in a localized interdigital or global distribution).
• Juvenile plantar dermatosis tends to affect the balls of the feet bilaterally with a shiny, smooth appearance (“glazed doughnut”). The involvement of the interdigital spaces is more often seen in tinea pedis.
• Allergic contact dermatitis usually affects the dorsum of the feet, sparing the toe webs and soles.
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