blood spot under foot

by kelly
(UK)

Hi I stood on a stone last year November time on the ball of my foot, which led to a kind of blood spot, I still have this and it really hurts if I wear shoes with thin soles or if the hard skin is to thick over it, sometimes aswel if I wear boots and walkin for ages it hurts so bad and the blood spot goes to triple the size but then shrinks after a few hours once I take shoes off, it's really annoying me now..what could it be and should I go and get it properly looked at ..if you could help that would be great,

RESPONSE

Hi Kelly,

The short answer to your question is yes, you should probably have this looked at by a doctor simply because four months have passed and you still have this issue.

I think we can both agree that by standing on the rock that you mention, you did some damage to the tissue under the ball of your foot.

As I can best make out from your picture, it appears that you have a callus under your second metatarsal head and I wonder if that was there prior to standing on the stone. If so, that would suggest to me that you have what is known as a plantarflexed second metatarsal meaning that particular bone is in a more downward position than the adjacent metatarsal bones, so it bears more weight when you walk and therefore have developed a callus.

By stepping on a stone you made the situation worse by adding more pressure to the bone and thus did some degree of damage to the area. The bleeding is due to the excessive amount of pressure you are exerting on the area; in other words the area is bleeding underneath the callus.

So, the more you walk, the more pressure you exert, the more it will bleed.

What troubles me is that we generally see this in older individuals (you appear fairly young) and many of these older individuals are diabetics or have poor circulation.

I am not implying that you have either of these issues but again, someone your age should not be having bleeding underneath your callus.

Assuming there is no serious underlying medical problems there is also the issue of pain. You probably have a bone bruise as a result of the rock incident which is exacerbated by the plantarlfexed second metatarsal. Together this will cause a lot of pain, particularly if you do a lot of walking. If in theory you could stay off your foot for a few weeks, the discoloration would go away and the bone bruise would also resolve, however, you would still be left with the plantarflexed second metatarsal as that is a structural issue, ie: it is your "normal" foot structure.

Since it is unlikely you can go on crutches for a month, the smarter move would be to see a foot specialist in your area, first to make sure the bleeding under the callus is nothing serious and secondly to work on reducing the pain in the area.

In most cases of a plantarflexed second metatarsal with pain (they all do not have to hurt), the doctor will probably make a device that you can put in your shoe, called an orthotic. This device would have materials added to it around the painful area to keep pressure off the spot when you walk. Eliminate the pressure, you end up eliminating the pain; it is that simple.

I should add sometimes just having the doctor scrape away the callus (a painless procedure) will also give the patient immense relief, but I should also mention that the relief can be short lived because if your metatarsal is plantarflexed, the added pressure will eventually cause another callus to form.

Marc Mitnick DPM
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