Strange Bruise-Like Bump on Second Toe

by Bill
(Indiana)

Hello. Recently, I noticed that I have a very small, bruise-like bump on the middle top of my second toe (the toe next to the big toe) on my left foot. It is located to the right of the joint. This bluish/dark purplish-colored bump is almost perfectly round and feels as though it is under my skin -- almost as if I have a tiny stone (about 1/8 inch in diameter) under my skin. It only hurts slightly if I touch it. I do not remember injuring my second toe at all. I am wondering what this tiny, dark-colored bump under my skin could be and if and/or when I should see a doctor about it. Thank you in advance for all of your help.

RESPONSE

Hi Bill,

Without the luxury of actually being able to examine your foot I am only guessing here. Since it is a "questionable" growth, you should certainly see a local doctor who can make an accurate diagnosis.
Having said that, the most common cause of a purplish discoloration on the top of your second toe would probably be the result of shoe irritation on top of the toe. I am guessing here that you may have a mild hammertoe deformity, whereby the toe is not exactly straight, but rather bent at the level where the discoloration is occurring.
When you wear a shoe that is either a bit too short, which forces the second toe to bend at that level, or if you are wearing shoes that do not have a high toe box, then what happens is you get pressure on the part of the toe that you mentioned.
The constant rubbing creates irritation. Some people will develop a corn or hard skin. Others will just develop irritation.
Both of these situations can also have some bleeding occurring underneath the skin from the excessive irritation.
This bleeding will then cause the discoloration that you seem to be experiencing. Depending on your age and overall health, this area could further breakdown to the point that it may get infected with pus coming out.
Typically the second toe is the most commonly affected because many people have a second toe that is longer that the big toe. (manually straighten yours out to see if it is actually longer than the big toe0. Thus if the second toe is longer than the big toe, it is usually the second toe that hits the end of the shoe and is forced to bend at the joint when wearing a shoe that might be slightly too small for the foot.
This is the most common cause of your symptoms, however other conditions need to be ruled out.
I have seen an inflamed vein present itself in the manner which you describe. The vein is just under the skin and right above the toe bones, so there is no room for the vein to "hide" if there is excessive shoe pressure.
Another consideration would be the possibility of a small ganglion or synovial cyst. The ganglion cyst usually comes from the tendon over the toe while the synovial cyst will arise from the joint itself.
Sometimes these growths will have blood in them and thus will have the purplish discoloration you mention.
So, if you are concerned enough and there is discomfort, why not see a foot specialist in your area and find out exactly what your problem is?

Marc Mitnick DPM
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