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Bruise and lump on 2nd metatarsal

by India
(New Zealand )

Just over 2 weeks ago I discovered a slightly large bruise and a good sized lump on my 2ND metatarsal. The bruise spreads from just on my 2ND metatarsal to my 5th metatarsal. It is a circular shape. The lump increased in size the day after I had noticed it. It almost tripled in size. It has gone down a lot since and the bruise it disappearing but still evident. About 3 days ago I felt my foot and discovered the my 3rd metatarsal is extremely tender to touch. The lump on my 2nd metatarsal is still there and i see not decreasing anymore. It is probably the size of a medium/small medium marble. Another thing to note is that it is not sore most of the time when I was but it does feel tight on the top of my foot where the bruise is and it does feel a bit weird. What might this be?


RESPONSE

Hi India,

Of course without actually examining you, I am only guessing what might be going on. First I will discuss the two most common causes of swelling (and pain) on top of the second metatarsal.

The most common cause of pain in that suspected area would be a tendonitis of the tendon that allows you to bend your toe upwards.

This can happen for no apparent reason other then perhaps doing a lot of walking the day before, or walking in a poor fitting pair of shoes. The fact that the swelling had spread towards the fifth metatarsal "might" be due to a similar situation with the tendons that affect the third, fourth and fifth toes.

Since they may have been affected to a lesser degree that might explain why the swelling in that area appears to be subsiding.

Tendonitis tends to be a self limiting condition, however, in the foot it can last quite a while simply because every time you walk, the tendons are continually aggravated. Immobilization, rest, moist heat and anti-inflammatory medication (assuming you can tolerate it) would be indicated.

The next most common source of pain the area you mention would be from a stress fracture. Yes, simply walking, again either in a poor fitting shoe or just doing a lot of walking can cause the second metatarsal bone to spontaneously fracture.

The only way to know if there is a fracture is with an x-ray. It should be noted that sometimes a small crack in the bone will not show up initially on x-ray and either the x-ray needs to be repeated in 10-14 days or an MRI or bone scan may need to be performed to rule out a fracture.

Those are the two most common causes of your symptoms. However, you certainly cannot rule out the possibility of a soft tissue growth of some sort. The most common growths are ganglion cysts and synovial cysts. Both are benign growths that may or may not hurt.

Since it does not sound like you are in a lot of pain, you might consider waiting another week to see if the swelling continues to diminish. There is a good chance it will not and if so you should see a local doctor who will order an x-ray and then be able to determine the source of your swelling. It goes without saying that if the swelling starts to worsen, you should see a doctor immediately.

Marc Mitnick DPM
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