Painful lump ontop of 3rdand 4 th metatarsals

I am an iron man triathlete who has developed a small but very painful lump on the top of my foot 3rd -4th metartarsals , Causing problems walking and a throbbing pain constantly ! This lump came up over night 3 days ago , I have had a x Ray suspected stress fracture but this was clear ( I have had a stress fracture before and the pain was not the same ) the doctor then thought I had a tear in the tendon . I'm not sure about it being a tear as the pain is isolated to the lump the rest of the foot is fine ? I'm due to go back to the doctors on Wednesday if the pain doesn't subside , but with a big race in two months time I would like to know what this is as I currently can't run or cycle ! I'm hoping you might be able to help :-)

RESPONSE

Hi,

Let me start off by giving you my disclaimer. Without actually examining you, I have no real idea what your problem is. Having said that I will give you some insight as to what it might be.

Even with a negative initial x-ray, you cannot be 100 percent sure that there is no stress fracture. Sometimes small fractures will not show up initially and either the x-ray has to be repeated in about ten days or you may have to consider a bone scan which will show fractures where x-rays fail to. Based on your situation, if everything else proves negative, that might be the thing to do.

I am not leaning toward a stress fracture simply because if you actually have one, it would be a small crack in the bone and this would not cause a lump to form on the top of your foot. A lump can be seen with larger fractures where bone callus forms and this can be felt on the top of the foot.

I really doubt you tore one of your tendons. Without a history of actual trauma to the top of your foot, such as dropping something on it, or someone stepping on it, the extensor tendons (the tendons on top of your foot) generally do not spontaneously tear from exercise. The flexor tendons, (the tendons on the bottom of your foot) would be more prone to spontaneous rupture.

So where does that leave us. A lump on top of your foot could mean a couple of different things.

The first would be the possibility that you have a tendonitis and because of the swelling, you are feeling the inflammation which is resulting in the lump. By moving the toes up and down, the lump should move back and forth if it the tendon that is affected.

Another possibility is that you developed a soft tissue growth in a matter of a few days. Two common things that come to mind would include a ganglion cyst which could be coming off one of the tendons or a synovial cyst which would be arising from one of the joints on top of the foot. Again, without examining you, I have no idea.

If the lump is also red and very tendon, you also have to rule out the possibility of an inflamed vein, more commonly known as a superficial phlebitis. There is a large network of veins on the top of the foot and there is always a chance one of them became inflamed.

So, those are the conditions come to mind. Work with your doctor to figure what your actual problem is.

Marc Mitnick DPM
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