II. Epidemiology
- Often the first vaso-Occlusion crisis finding in young children (as early as 6 months of age)
- Occurs in up to 50% of children with Sickle Cell Anemia by the age of 2 years
- Rare over age 4 years old
III. Pathophysiology
- Not to be confused with Hand Foot Syndrome that occurs with certain Chemotherapy agents in non-sickle disease
- Occurs in Sickle Cell Anemia with vaso-Occlusion
- Hematopoiesis occurs in the peripheral extremities in younger children
- As children age, hematopoiesis shifts to the more proximal extremities
- Caused by ischemia or infarction of Bone Marrow
- Affects Metacarpal or Metatarsal Bones and phalanges
IV. Symptoms
- Painful swelling and tenderness of either the dorsal hand or foot
- Non-pitting soft tissue swelling over the dorsal, proximal hand or foot (Metacarpals/Metatarsals, proximal phalanges)
- Digits may appear mildly erythematous
V. Signs
- Low grade fever (variably present)
VI. Imaging
- No bony abnormalities (contrast with other disorders on the differential diagnosis)
VII. Differential Diagnosis
VIII. Course
- Dactylitis episodes resolve spontaneously within 1 week
- Dactylitis before age 12 months predicts severe lifetime Sickle Cell Disease (RR 2.6)
IX. References
- Lopez (2025) Crit Dec Emerg Med 30(3): 4-12
- Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23
