Photoclinic: Symmetric Ankle Bruises

The mother of this 5-month-old infant was concerned about the lesions that appeared on her son's inner ankles after he had spent the day with his babysitter. The lesions had not been present when the child was dropped off earlier that morning. His grandmother feared they might be cigarette burns.

Howard Fischer, MD, and Teresa G. Holtrop, MD, of Detroit found the infant to be healthy and well-nourished. He had bilateral, symmetric, roughly circular abrasions, about 1 cm in diameter, on the medial malleoli (A).

On further questioning, the mother revealed that among the items she had given to the babysitter was a new pair of rather rough-soled sandals (B). When the sandals were placed on the infant's feet, he immediately started rubbing the instep of his sandal over the medial malleolus of the contralateral foot.

Although symmetric wounds, especially burns, suggest child abuse,¹ it was believed that in this case, the abrasions were self-inflicted by a child who was unhappy with his new footwear. The mother was advised to refrain from putting the sandals on the child.

References:

REFERENCE:

1. Wissow LS.

Child Advocacy for the Clinician: An Approach to Child Abuse and Neglect.

Baltimore: Williams and Wilkins; 1989:63.