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Big toe pain/bump

by Jennifer
(Colorado)

inflamed bursal sac?

inflamed bursal sac?

inflamed bursal sac?

I have a bump at the joint of my left great toe and foot. This lump is painful at times, firm, and the (what I am assuming to be) nerve rolls when it is touched. Depending on the day I either feel pain or tingling when it is touched. The area itself is slightly numb. I did have a bone graft in the joint approximately 4 years ago. I have went to the Dr. The first visit I was told it was nothing. The second (after it got worse) I was told it was an infection and put on two antibiotics. Now two weeks later, after finishing my perscribed antibiotics, the lump and pain is still there. I have tried staying off my foot but the DR said it is nothing to worry about. Due to working as a Caterer/Restaurant manager I am on my feet all of the time. The Dr has done an X-ray, and said there was "slight inflammation" but again nothing to worry about. Due to the pain I am considering returning back to the DR, but due to the DR not really doing anything I am hesitant. All I want to know is if this is something I have to "live with" or if this can be treated. The feeling of nerve involvement also has me a little worried.


RESPONSE

Hi Jennifer,

Your problem is not something you should have to live with. I realize I am on the other side of the internet and the only thing I have to go by is your picture. I cannot examine you, nor can I see x-rays.

Having said all that, since you apparently had some sort of surgery in that joint four years ago, (not sure why you would have a bone graft), it appears to me that the red bump may be an overgrowth of bone that can happen at sites where there has been previous surgery.

I am wondering what type of doctor you have been going to. Is he or she a foot specialist or is this your family doctor?

The
redness to me does not seem to be an infection. Unless there was some sort of cut or abrasion to that area of the foot, then I do not know how it would have gotten infected.

To someone like me, just looking at the picture, the redness appears to an inflamed bursal sac which will typically occur in this area from the chronic pressure of the bone against your shoe, particularly since you stand long hours. Again, I could be wrong, because i do not have the luxury of examining you.

You are correct about the feeling of nerve pain in the area. One of the nerves that comes down into your foot, travels over the bony prominence and it too will get caught between the bone and the shoe. It can give you sensations of numbness, or burning and tingling.

I do not know how old you are, but if you are past menopause, there is also the possibility of a gout attack. I am leaning away from that diagnosis because the only area that is red is the bony bump, where in a gout attack, usually the whole joint will be affected. Additionally, most gout attacks are self limiting and will subside on their own over the course of seven to ten days.

Assuming I am correct in my diagnosis of an inflamed bursal sac, if you came into my office, the first thing I would do is offer you a cortisone injection to see if I could quiet down the area.

I would also check the types of shoes that you wear to make sure that they are wide enough and soft enough to allow for the bony prominence on the inside of your foot.

If that did not render relief, then I might suggest surgically removing the bump. Not knowing what your actual joint looks like, nor knowing what type of previous surgery you had, more involved surgery might be necessary.

My suggestion to you would be to see a different doctor, one who specializes in the care of the foot.

Marc Mitnick DPM
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