Pseudodystrophy of the ankle and lower leg in a 9-year-old girl

A 9-year-old girl presented with pain, swelling, redness and functional impairment of the left foot after a minor trauma. Clinical assessment revealed atrophy of the left calf and cyanosis and coldness of the left foot. Bone scintigraphy showed diffusely decreased tracer uptake in the left lower leg. Further examinations were normal. Pseudodystrophy was diagnosed and intensive physiotherapy was started. This resulted in complete functional recovery. Pseudodystrophy is typically found in children, adolescents and young women. The clinical features usually include severe pain at a joint or part of a limb with major functional disability, cyanosis, coldness and oedema or atrophy. This is caused by disuse of the affected limb after a minor trauma. The physical lesions may be improved or cured by means of intensive physiotherapy, sometimes combined with medication. As psychogenic factors often play an important role, one of the important elements of treatment is psychotherapy. The most important differential diagnosis is reflex sympathetic dystrophy (RSD). The distinction can be made by bone scintigraphy.