[39F] With painful lumps on feet and lower leg symptoms

Patient Description

A 39-year-old female has been experiencing significant pain and tightness in her feet and lower legs for the past 6-7 months. This pain is associated with lumps under the skin on both arches of her feet. The pain and tightness are severe enough to make walking very difficult, often causing her to cry, and it can take over a day of rest to feel pain-free. The tightness feels like her feet are being squished after wearing shoes and walking for a short time. The lumps have grown in size and number, with the right foot being more affected. The lumps become red after prolonged standing or driving. She has not experienced any numbness or tingling in her feet or lower legs. However, she has noticed changes in the shape of her feet, such as swelling in the arches, toes appearing closer together, and the presence of bunions. She also mentioned the appearance of purple veins around her knees when her feet are swollen and painful. She has a history of knee issues since her early twenties, which worsened after her last child. She does not have any other significant medical conditions, and she is up to date with her vaccinations. She is allergic to penicillin, Tylenol, and gabapentin, and currently takes Motrin as needed and over-the-counter allergy medications during allergy season. She does not use any topical creams or have any prescribed medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Plantar Fibromatosis (Ledderhose Disease)

  • Description: This condition involves the development of benign (non-cancerous) lumps or nodules in the arch of the foot. These lumps can cause pain and discomfort, especially when walking or wearing shoes.
  • Rationale: The lumps under the skin on the arches of your feet, along with the pain and swelling, are consistent with this condition.
  • Typical Treatments: Treatment may include orthotic devices to relieve pressure, physical therapy, corticosteroid injections, or in severe cases, surgery to remove the nodules.

Bunions and Foot Deformities

  • Description: Bunions are bony bumps that form on the joint at the base of your big toe. They can cause pain and lead to changes in the alignment of your toes.
  • Rationale: The changes in the shape of your feet, such as the appearance of bunions and toes moving outward, suggest that bunions and related foot deformities may be contributing to your symptoms.
  • Typical Treatments: Treatment may include wearing wider shoes, using bunion pads, taking pain relievers, and in severe cases, surgery to correct the deformity.

Varicose Veins

  • Description: Varicose veins are enlarged, twisted veins that can cause pain, swelling, and a heavy feeling in the legs.
  • Rationale: The appearance of purple veins around your knees and the swelling in your feet and lower legs suggest that varicose veins may be contributing to your symptoms.
  • Typical Treatments: Treatment may include compression stockings, elevating your legs, exercise, and in some cases, procedures to remove or close the varicose veins.

What you can do

For Plantar Fibromatosis

  • Orthotic Devices: Consider using custom orthotic devices or insoles to relieve pressure on the lumps and provide better support for your feet.
  • Footwear: Wear comfortable, supportive shoes with a wide toe box to reduce pressure on the affected areas.
  • Physical Therapy: Engage in physical therapy exercises to stretch and strengthen the muscles in your feet and lower legs.
  • Pain Relief: Use over-the-counter pain relievers like Motrin (ibuprofen) to manage pain and inflammation.

For Bunions and Foot Deformities

  • Footwear: Choose shoes that are wide and have a soft, flexible sole to accommodate the bunions and reduce pressure on your toes.
  • Bunion Pads: Use bunion pads or cushions to protect the bunion and reduce pain.
  • Toe Exercises: Perform toe exercises to maintain flexibility and strength in your toes.
  • Consult a Specialist: See a podiatrist or orthopedic specialist for a thorough evaluation and to discuss potential surgical options if conservative treatments are not effective.

For Varicose Veins

  • Compression Stockings: Wear compression stockings to improve blood flow and reduce swelling in your legs.
  • Leg Elevation: Elevate your legs whenever possible to reduce swelling and improve circulation.
  • Exercise: Engage in regular physical activity, such as walking, to promote healthy blood flow in your legs.
  • Consult a Specialist: See a vascular specialist to discuss potential treatments for varicose veins, such as sclerotherapy or laser therapy.

What you should look out for

Given the severity of your symptoms and the impact on your daily life, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Increased Pain or Swelling: If you notice a sudden increase in pain or swelling in your feet or lower legs.
  • Changes in Skin Color: If the skin over the lumps or affected areas becomes red, warm, or discolored.
  • Numbness or Tingling: If you experience numbness, tingling, or loss of sensation in your feet or lower legs.
  • Difficulty Walking: If the pain and tightness make it increasingly difficult to walk or perform daily activities.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and personalized treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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5 mo ago


People Also Ask


What is plantar fibromatosis and how is it treated?

Plantar fibromatosis, also known as Ledderhose disease, is a condition where benign lumps or nodules develop in the arch of the foot, causing pain and discomfort. Treatment options include using orthotic devices, physical therapy, corticosteroid injections, or surgery in severe cases.


How can bunions affect the shape of my feet and what are the treatment options?

Bunions are bony bumps that form on the joint at the base of the big toe, causing pain and changes in toe alignment. Treatment options include wearing wider shoes, using bunion pads, taking pain relievers, and potentially surgery to correct the deformity if conservative treatments are ineffective.


What are varicose veins and how can they be managed?

Varicose veins are enlarged, twisted veins that can cause pain, swelling, and a heavy feeling in the legs. Management includes wearing compression stockings, elevating the legs, regular exercise, and possibly medical procedures like sclerotherapy or laser therapy to remove or close the veins.


When should I seek medical attention for foot pain and swelling?

You should seek medical attention if you experience a sudden increase in pain or swelling, changes in skin color over the affected areas, numbness or tingling, or if the pain and tightness significantly impair your ability to walk or perform daily activities.

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