The patient was an 18-year-old student who visited the dermatology clinic for evaluation of a painful “bump” on the ball of his foot. The lesion had been present for three months. The patient described a dull pain at the site of the growth, which was exacerbated when he ran or played basketball. He had tried many times to file down the bump, often until it bled, and on several occasions, he had tried to cut out the “root” with a razor blade, but the lesion would not resolve. The patient’s medical history was unremarkable, and he had no other skin complaints. No household contacts exhibited similar lesions.
A 72-year-old woman presented with a six-month history of a painful lump on the side of her right middle toe. She described the pain as dull and stated that it worsened when she walked or wore shoes for a prolonged period of time. She noted that she had tried scraping at the lump with a pumice stone several months before, which helped temporarily. The patient’s medical history was significant for type 2 diabetes as well as podiatric surgery on her left foot. In addition to the lesion, examination revealed onychomycosis and a prominent proximal phalanx head on the affected toe.