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Sickle cell dactylitis, also called hand-foot syndrome, is a painful swelling of the hands and/or feet due to ischemic infarction of bone marrow and cortex in young children with sickle cell disease (SCD). It is the earliest and most common skeletal manifestation of SCD.

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Epidemiology

• Age: 6 months to 5 years (after HbF declines).
• More common in African and Indian populations where SCD is prevalent.
• Often the first presentation of sickle cell anemia in infants.

Etiopathogenesis

• Sickled red cells → vaso-occlusion in nutrient and periosteal vessels of small tubular bones of hands and feet.
• Results in bone marrow infarction, subperiosteal new bone formation, and periostitis.
• Repeated episodes may cause chronic deformities.

Clinical Features

• Acute onset of painful swelling of hands and/or feet.
• Symmetric, tender, warm swelling without obvious trauma.
• Fever may be present (can mimic infection).
• Resolves spontaneously in 1–2 weeks but tends to recur.

Radiology

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Radiographs show subperiosteal new bone, cortical irregularity, and symmetric involvement. It mimics osteomyelitis but is usually bilateral.

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