A 32-year-old woman presented with a one-month history of pain in her right foot, under the fourth toe at the base of the proximal phalanx. About one month before presentation, she stepped on broken glass. She thought she removed all glass fragments at the time but noticed worsening pain since then. Walking intermittently caused sharp, localized pain. She had no additional symptoms, including fever, chills, or rash. She did not have skin changes, lumps, or discoloration in the painful area. She had no relevant family, medical, or social history. 

Physical examination revealed a faint, circular, sharply demarcated nodule approximately 6 mm to 7 mm in diameter. It was light gray with no surrounding erythema, firm, and moderately tender on palpation. Radiography was performed (Figure 1).

Question

Based on the patient's history, physical examination, and radiography findings, which one of the following is the most likely diagnosis?

• A. Foreign body.

• B. Morton neuroma.

• C. Osteomyelitis.

• D. Osteophyte.

Discussion

The answer is A: foreign body. Most foreign bodies are introduced into the skin through lacerations and soft tissue wounds. Complications include chronic pain and neurovascular impairment. Assessment should include radiography or ultrasonography before removal.¹ Contraindications for removal include the foreign body is close to a vital structure or cannot be located, or the patient is unable to tolerate removal.¹