13 yr boy has difficulty in standing and walking on left leg since 1 month.no h/o trauma;injury:back pain;..no tingling or numbness..MRI spine was normal.O/E spine,hip and knee movements & power was normal..no swelling/warmth/redness/tender over above..there was swelling over foot(left)(plantar>dorsal).no warmth/redness..tender over foot(dorsal>plantar).weakness of dorsiflexor and finger drop..video is attached..pls suggest for further..RA factor is normal.uric acid is normal.peripheral pulse and nerves are normal..



There seems to be soft tissue element in the case my observation suggest pt has probably tenosynovitis lt ankle try ankle binder ice cold packs NSAIDs and short course of antibiotics brace to be use for 3to4 weeks and physiotherapy if there is h/o fever go for cbc esr also check bsl and r/o rheumatic episode

Thanx dr Anand Kumar

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What is obvious is an antalgic gait He is favouring the injured leg The injury could be any where from hip down wards Localise by clinical examination Confirm with xrays There is some swelling of foot and reduced movements.

There is no h/o injury..MRI spine was normal..x ray foot is normal..but there is marked swelling ,tenderness and power loss at foot.

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My first impression is pauciarticular Juvenile Rhematoid arthritis. Post viral arthritis/artgralgia is also possible. R A factor is not diagnostic nor does it rule out RA. ,A clinical diagnosis is enough.

Possibly JIA but I can't see swelling on any joint or on dorsal aspect of foot which should be there if there is metatarsal involvement in JIA which is again not very common . As mentioned if swelling is there on plantar aspect of then possibly some thorn embedded in soft tissue which initially went unnoticed or plantar fasciitis is also possible as his gait is like something paining & child is trying to avoid wt bearing on that foot .

Most children with JIA are misdiagnosed initially simply because it mimics practically any joint antalgia. Time will tell. Metatarsal involvement is always difficult to demonstrate,but small joints are clasiccaly responsible for painful gait. Plantar fasciitis is rare in children

It's a case of rheumatoid arthritis.analgesics needs to be started for better relief.

Gait is not suggestive of any primary neurological problem.

Arthritis, Rx- investigation like Serum Calcium, Vitmn D, B12, CBC, Protin deficiency, must be in the mind to evoulate the Picture.


Juvenile rheumatoid arthritis

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