“My feet hurt,” said a twenty-year-old college student. We wondered, could he be in the wrong office? Shouldn't he be seeing an orthopedic surgeon, podiatrist, or rheumatologist? But no, since these other physicians had shunted him off, he came to see us as an orphan patient.

As he was lying disrobed on the examining table, we saw only perfectly normal skin on his feet, as well as elsewhere. At least we could tell him he had no suspicious-looking moles or melanoma. But, we listened to his story. He had never had any problem with his feet until this summer when he went to work as a railroad trackman. He wore comfortable proper-fitted shoes, yet within a week of starting work his feet had become painful. He had continued to work until he saw us.

The feet seemed normal. They had never been injured. There were no tender spots. Motion was normal, both passive and active. Complete vascular assessment was unrewarding. We contemplated getting x-ray views of his feet to check for the presence of bone spurs. We also heard him say repeatedly, “It only hurts when I stand for a long time.” Could this be a paresthesia from pressure on the sciatic nerves? The answer came when we asked him to get off the table and stand up. Immediately on standing, firm bumps appeared on the medial aspect of both heels.