Photo Rounds

Painful toes

A previously healthy infant was brought to the emergency department by her parents, who said that their child was experiencing significant toe pain. Two reddened, swollen toes were immediately identifiable on the left foot. The parents denied any trauma involving the infant.

What's your diagnosis?


 

Upon closer inspection, the physicians discovered hair thread tourniquets constricting the fourth and fifth toes on the baby’s left foot.

Hair tourniquet syndrome primarily affects infants in the first few months of life. The average age of occurrence is 4 months, a time when maternal postpartum hair loss is at its maximum.

Toes are most frequently involved, although cases of hair tourniquets affecting the fingers, penis, labia, clitoris, and uvula have been reported.

To remove this patient’s hair tourniquets, the physician carefully cut the fibers with hooked Littauer suture-removal scissors and unwrapped the hair. Damage to the plantar aspect of both toes was significant enough that the physician had to cut through the soft tissue and into the flexor tendon to completely remove the hair. No sutures were required, as the wound edges were well approximated without closure.

The injured toes were cleaned and dressed. The patient’s recovery was complete and uneventful.

Adapted from: Moore EP, Strout TD, Saucier JR. Photo Rounds: Crying infant with painful toes. J Fam Pract. 2012;61:675-677.

Recommended Reading

ACP urges changes to curb prescription drug abuse
MDedge Family Medicine
Drug or sham? Migraineurs responded to placebo 40% of the time
MDedge Family Medicine
Jaw pain
MDedge Family Medicine
Make the most of nonopioids: Managing acute pain in children
MDedge Family Medicine
FDA: Stop prescribing combo drugs with high-dose acetaminophen
MDedge Family Medicine
Rash on trunk
MDedge Family Medicine
Environmental stressors play major role in pediatric migraines
MDedge Family Medicine
Chronic use of NSAIDs, statins had no effect on PSA values
MDedge Family Medicine
Treating migraine: The case for aspirin
MDedge Family Medicine
FDA: Naproxen may pose lower CV risk
MDedge Family Medicine