OpenHealth Q&A

Black Spot on Foot Post-Surgery: Seeking Insights

Date: March 15 Subject: Appearance of a round, dark mark approximately one inch in diameter located on the underside of my right foot, adjacent to the heel. This happened following the complete removal of my toenail, which was performed on March 12. Demographics: 22-year-old male. Current Medications: I take 200mg of Sertraline and 100mg of Bupropion SR each morning, switching to 50mg of Sertraline and 100mg of Bupropion in the afternoon. These are prescribed to manage severe obsessive-compulsive disorder, a condition I've been dealing with since September 2024. Medical History: I was diagnosed with Ehlers-Danlos Syndrome by a rheumatologist. Although I have not consulted a geneticist, I do not exhibit any genetic heart defects based on past echocardiograms. I had a minor mitral valve prolapse along with pericardial effusion from January to April 2021, which resolved spontaneously. Additionally, I experience severe ankle instability, requiring prescription ankle-foot orthoses (AFOs) for both feet due to my tendency to overpronate while walking. My feet are predominantly flat, and I have a bulging annulus between C4 and C5 vertebrae, along with occipital neuralgia and left-sided sciatica. This marks the third instance of complete toenail removal for my right big toe. The initial procedure occurred in 2017 due to an infected nail bed along with a fungal nail infection, at which point the nail was already partially detached. The second removal was in 2020 for another fungal infection that led to improper nail growth, leaving it underdeveloped. The most recent removal was prompted by yet another fungal infection. During my initial evaluation, x-rays of my feet revealed the presence of multiple bone cysts. Unfortunately, I cannot access these x-rays through the patient portal. During the toenail removal procedure on Tuesday, it was revealed that the previously underdeveloped nail had begun to detach and was slightly ingrown. The initial administration of local anesthesia was excruciating, resulting in significant bruising around the injection sites—a contrast to my past toenail removal experiences where I didn’t experience such discomfort or bruising. The surgery concluded around 3:30 PM on Tuesday. I changed my bandage at 9:45 PM the following day, using advanced wound wash from CVS to cleanse the area, drying it gently with gauze. I applied antibacterial ointment using a different gauze pad and then secured it with cloth tape without showering beforehand. The next day, I repeated the cleansing process at 8:20 AM after taking a shower, ensuring to protect the toe with a finger cot prior to showering, even though it caused some pressure on the area. For Tuesday through Thursday, I mostly remained seated with my feet elevated to hip level and used a wedge pillow to keep my legs elevated while sleeping. During any brief moments of walking, I favored my left foot and placed minimal pressure on the outer edge of my right foot to avoid discomfort. Pain Relief Log: I took doses of ibuprofen: - 400mg at 4:30 PM and again at 9:45 PM on Tuesday. - 400mg the following morning at 6:45 AM (woken by pain in my right big toe). Continued with doses of 400mg at 12 PM, 4:10 PM, and 8:40 PM on Wednesday, followed by 400mg at 2:20 AM and 200mg at 11:25 AM on Thursday. No further painkillers have been taken since. Earlier today, I ascended and descended the stairs once at around 9 AM and stood for about 15 minutes. I can currently apply weight across most of my foot, with the exception of the area surrounding the ball, extending from my second-to-last toe to the big toe. Since then, I have maintained a seated position with my feet elevated, save for short trips to fetch food or visit the restroom. Recently, I noticed a sizable brown spot, roughly one inch in diameter, near the heel of my right foot. It predominantly resides on the underside of my foot, extending only slightly to the side. Running my fingers across the sole reveals that the upper section of the spot is more tender than the surrounding areas of my foot, although the texture appears consistent with the rest of the sole. Given the sharpness of the edges, I’m unsure if it’s a bruise, but I hope to be mistaken. I appreciate any assistance or insights offered regarding this issue. I’ll gladly provide further details if necessary.

Answers (1)

8/15/2025, 7:11:36 PM

OpenHealth AI

It sounds like you’re experiencing some concerning changes in your foot after recent surgery. The appearance of a round, dark mark near the heel of your foot, especially after the removal of your toenail, warrants careful observation. Here’s what you need to consider:

Main Points

1. The dark spot may be a bruise, but it could also indicate other complications like a hematoma or infection.
2. It is essential to monitor the spot for changes, such as increased tenderness, swelling, or discharge.
3. Maintain good wound care practices to promote healing and prevent infection.

Explanation

The removal of a toenail can lead to bruising or other changes to the surrounding skin, especially if there was significant trauma during the procedure. Given your history of sensitivity and the previous pain during anesthesia, a bruise or hematoma (a localized collection of blood outside blood vessels) could form, especially if there was significant manipulation around the area. However, the fact that you mentioned tenderness and the sharpness of the edges also raises the necessity to monitor for possible infection.

Next Steps

1. Continue Monitoring: Observe the spot over the next few days for any changes. Pay attention to:

   • Size (increased diameter)
   • Color changes (darkening or spreading)
   • Tenderness (increasing pain)
   • Signs of infection (redness, warmth, swelling, or discharge).

2. Wound Care: Maintain cleanliness and use an antibacterial ointment as you’ve been doing. When changing the bandage:

   • Clean the area gently but thoroughly to avoid irritation.
   • Ensure that the bandage is not too tight, which could increase pressure around the area.

3. Pain Management: Since you're already using ibuprofen for pain relief, continue this as needed but maintain a focus on following the dosage instructions.

4. Limit Activity: Given your desire to keep weight off the affected area, continue to avoid putting pressure on your foot as much as possible until you feel confident about the healing progress.

5. Contact a Healthcare Professional: If the dark spot becomes increasingly painful, larger, or shows signs of infection (such as drainage or extreme tenderness), consider reaching out to your healthcare provider for further evaluation.

By following these steps, you can help ensure a better recovery process while keeping an eye on the changes in your foot. Please let me know if you would like more information on specific aspects of care or if you have any further concerns!