turf toe

by mark
(boston)

Hi Dr Marc

I had emailed you previously about 3-4 weeks ago I was playing soccer and put my foot down and felt and heard a pop in the ball of my left foot. Felt pain immediately in the ball of the foot right were the arch started. I uploaded a pic at the time. Could not walk without pain (not sharp pain but painful) for a few days. It has gotten better but when I massage and feel the spot marked in the pic with my hand I feel a lump. I have been rolling a tennis ball under my foot and over that spot it is not painful but with a smaller harder golf ball I feel sore but after few seconds it goes away.

I have not run or jumped on this foot, restricted my exercise and am using steel inserts in the front of my shoes to avoid bending the big toe. My doc had said it was probably a turf toe injury. Is that little lump typical. Don't think I fractured any sesamoid bones since I could walk without pain in about 1 week after the injury but running was painful in the area marked and radiated to the bottom of my foot.

Tried light running and jumping, no pain, no stiffness. Bending big toe back no pain or tightness, rolling tennis ball no pain or discomfort, golf ball, discomfort but goes away in a few seconds. What do you think this bump is? When I massage it, it is not a hard lump, maybe scar tissue on the hallucis ligament/tendon?

The lump is not visible to the naked eye but I can feel it when I wear a shoe with a high arch and when I touch and press that area.

RESPONSE

Hi Mark,

Well for starters it is not turf toe; actually not even close. It also does not appear to be sesamoiditis as the circled area is too far back.
What it does sound like in descending order from most probable to least probable would be:
1. A plantar fibromatosis (you can read about it by going to my navigation bar to the left). It is a herniation of the plantar fascial ligament. In most cases it will feel like a small pea, both in size and texture. Sometimes they are painful, most times not. I would not recommend rolling the golf ball over it as that will just inflame it, although I understand the pain passes quickly. When you felt that "pop" the plantar fascial ligament tore and this lump occurred.
2. An actual tear of the plantar fascial ligament without a herniation. The plantar fascial ligament acts as a bowstring to maintain the congruity of the arch. Although tears are more common near the heel area, the ligament can tear any where along its course and again the popping you felt may be suggestive of that. If the lump you feel is round more so than just swollen in the area then I would still lean towards plantar fibromatosis.
3. A calcified vein. Although there would not have been any kind of trauma or popping sound, the superficial veins located just under the skin on the bottom of the foot can sometimes calcify and you would feel a hard lump. I am assuming you are reasonably young so this option is a remote possibility.
I would you suggest you see a foot specialist who can give you a definitive diagnosis. If it is a plantar fibroma and it does not really hurt, than you could probably resume your athletic activity. If it ends up being a tear in the ligament then rest and possibly some degree of immobilization would be required.

Marc Mitnick DPM
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