Foot swelling or edema is a common manifestation of many disease states. It may be part of a localized or generalized process. Unilateral foot swelling may develop from a variety of causes, including trauma (e.g., sprains, fractures), infection (e.g., cellulitis, osteomyelitis, abscess), angioedema (i.e., allergic reaction vs hereditary), vasculitis (e.g., Henoch–Schönlein purpura, Kawasaki disease), insect bites, snake bites with envenomation, lymphedema (i.e., hereditary, acquired), soft-tissue tumors (e.g., benign—fibromas, malignant—rhabdomyosarcoma, other sarcomas), or bone tumors (e.g., benign—exostosis and unicameral bone cyst, malignant—osteosarcoma and Ewing sarcoma). Pain may be a significant complaint with all of these etiologies except for angioedema, lymphedema, and benign tumors. Historical factors such as chronicity of symptoms (recurrent vs acute onset), environmental exposures, systemic symptoms, a family history of angioedema or lymphedema, underlying renal/cardiac/hepatic disease, medications, and a thorough physical examination will help determine the etiology of foot swelling. Bilateral painless foot swelling is more likely due to an underlying systemic condition such as nephrotic syndrome, heart failure, cardiomyopathy, cirrhosis, malnutrition, hypoproteinemia, renal failure, or pregnancy.

• The typical ankle sprain is an inversion injury that occurs in the plantar-flexed position. The lateral stabilizing ligaments are most commonly affected in this type of injury.

• Ankle sprains in children are less common than fractures because the ligaments of a preadolescent are much stronger than the growth plate or bone. Associated avulsion fractures are typically present if a ligamentous injury occurs.

• Most foot fractures in children result from direct trauma, such as crush injuries from a falling object or the child falling from a height.

• Acute traumatic compartment syndrome of the foot is the result of a serious injury such as a fracture, dislocation, and/or crush injury. Vascular injuries and coagulopathies are risk factors for the development of this condition.

• Acute, painful, unilateral foot swelling is often associated with infection or trauma. Chronic unilateral painful foot swelling over a period of weeks to months may indicate a malignant neoplasm of the soft or bony tissue.

• Recurring paroxysms of subcutaneous angioedema in the extremities, face, trunk, genitals, or the intestinal and laryngeal submucosae are the characteristics of hereditary angioneurotic edema. Family history is positive in 75% of patients.

• Unilateral or bilateral, neonatal pedal edema suggests a diagnostic evaluation for Turner syndrome, Noonan syndrome, or Milroy disease (hereditary lymphedema with autosomal dominant inheritance).

• Medications such as calcium channel blockers and vasodilators may cause peripheral edema. Oral contraceptives may predispose a female teenager to deep venous thrombosis/thrombophlebitis with lower extremity swelling.

• Findings associated with severe ankle sprains include swelling, bruising, pain on palpation, and a positive anterior drawer test of the ankle. Patients with all four of these findings are likely to have a lateral ligament rupture.

• Angioedema secondary to cutaneous vessel damage in Henoch–Schönlein purpura may be significant. It may precede the palpable purpura, and it is most prominent over the dorsal hands and feet, and the periorbital regions.

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