Plantar Wort, Capsulitis or Something Else?

author : AMSSM

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Below my 5th metatarsal on the ball of my foot I have a callus area. If I press on it there is a lump underneath the skin. It hurts to walk barefoot sometimes and I feel it biking after 45 min.

Member Question

Below my 5th metatarsal on the ball of my foot I have a callus area. If I press on it there is a lump underneath the skin (almost like a callus below the skin). It hurts to walk barefoot sometimes and I feel it biking after 45 mins into it.  I also feel it running after mile four. Any ideas on what this might be?

Answer by Vijay Jotwani, MD
Member AMSSM

Thanks for your question. Pain around the distal 5^th metatarsal (near the ball of your foot) could be due to a few different possibilities including metatarsalgia, a bunionette, or a stress fracture. If the pain is at the metatarsophalangeal (MTP) joint itself, you could have joint capsule inflammation or MTP joint arthritis. Pain within the soft tissue at the plantar aspect (bottom) of your foot and not on the bone or joint could be due to a plantar wart or corn. A plantar wart may give the skin surface a cauliflower-like appearance and include black dots within the skin as a result of small capillary hemorrhages.

Your description sounds most like a hard corn, also called heloma durum, which is the body’s formation of a hard keratin deposit under the skin in response to repetitive mechanical pressure. To help with the pain initially you could try a donut pad to take some pressure off the corn or have a physician remove the corn. In the long term, preventing mechanical pressure in that location will keep the corn from returning. This could be through better fitting shoes, perhaps with a wide toe box to avoid pressure along the outside of the foot. A review of your biomechanics may reveal hyperpronation or high arched feet that may benefit from a padded arch supporting orthotic to support proper foot biomechanics. Your physician may also recommend a metatarsal pad to decrease crowding between the ends of the metatarsal bones.

While this corn is troublesome, it is treatable and should not limit you from biking and running in the long term. Best of luck,

Vijay Jotwani, MD

Sports Medicine & Family Practice

Houston Methodist Orthopaedics & Sports Medicine

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date: July 14, 2015