Dear Sir,

 

I am writing from the UK after visiting your web-page.  My girlfriend has what appears to be a excess amount of bone on the top of each foot ( I think this may be the metatarsal?.  They appear as 'humps' - just as you would get on a camel!  The hospital here has suggested surgery but I am concerned and want to know all I can about this before any form of surgery takes place.  It may be that we travel to the US to have the operation.

 

I have searched endless websites but not been able to find anything about this.  Can you help? Thanks.

 

Olaf B.

Dear Olaf,

I should have addressed this before. Your girlfriend has a bony bump on the top of her foot where the first metatarsal bone meets the bone behind it, the cuneiform bone. It is technically a "First Metatarsocuneiform Exostosis" commonly called a dorsal bump. It is normally a benign and harmless little bump. But it does have a superficial nerve that runs right over the top of it. When the nerve is compressed between the shoe or ski boot and the underlying bone, pain results. 

Treatment for this can be conservative or surgical. If you know what shoe or shoes are he main culprits and you can avoid them, do so (this is the Henny Youngman* School of Medicine). Sometimes merely  lacing athletic shoes or hiking boots so that a lace misses the bump will do. Other times an pad can be affixed to the foot or the shoe that displaces weight and pressure away from the bump.

When conservative methods fail the bump can be easily and successfully removed. Here in the States the bump is removed under local anesthesia, possibly with sedation, but full anesthesia is not needed. A 2-3 cm incision is made directly over the bump and dissection is carried down to the bone. The bone bump is removed with either a little power saw or a hammer and chisel (osteotome and mallet in medical speak). Overnight stays in the hospital are not needed. We have patients walk the same day in a post-operative surgical shoe and they can wear regular shoes in 10-14 days after surgery when the sutures are removed. I ask my patients to keep the wound dry for the 10 days before suture removal. 

Just superficial to the bump is a cutaneous (skin) nerve and just to the side is the very important dorsalis pedis artery, so you want a reasonable experienced surgeon to perform this procedure.

Olaf, I do not think you have much to worry about. This is a relatively common problem and most foot surgeons get to do several a year. My advice -- go for it.

(* Henny Youngman was an American comic famous for one liners like: I went to the doctor and told him "it hurt when I did this". He said, "don't do that")

 

October 8, 2003

Dr. Michael Zapf and Dr. Darren Payne,

I have a hard bony lump on my left First Metatarsocuneiform joint which makes wearing shoes very uncomfortable.  I have had this lump for several years now, but as of this year it is now causing me more pain.  Once I take the culprit shoe off, the pain lasts for several hours.   My GP after seeing the x-ray had me see a specialist.  My GP believed the bump to be an osteochondroma, which as I understand is a common benign bone tumor, but she just wanted to make sure it was not an osteosarcoma.  I saw a specialist, and during the exam I seemed to come away with him telling me that I had a form of bursitis which surgery could help.  But from what I knew about bursitis, that diagnosis did not make sense to me.  I requested the report from the specialist which stated small exostosis over the cuneiform.  I am not sure if bursitis and metatarsocuneiform exostoses have anything in common.  Even though this is supposed to be a very common problem, I have not found much information about it online or on medline.  I was wondering how soon a patient can go back to normal activity after the surgical removal of the exostosis and what types of surgical complications are possible?  Knowing that there is a nerve that runs on top of that joint I was concerned about going through with surgical removal.  I figured since the pain wasn’t unbearable, I would try to just live with it and find shoes that were better suited for my feet.  If the procedure is actually an easy common one, I might be more interested.  Thanks for your help.

-Vail

Dear Vail,

Osteosarcoma? I should hope not but only your foot specialist (podiatrist or orthopedist) can help you there. Usually these are just bony bumps arising from a "jamming" of the first metatarsal on the first cuneiform bone. This is frequent in high arched feet. If this bump is not a bother it can stay. If it gets in the way (particularly problematic in ski boots) it can go with a 30 minute surgery. I do mine at the Surgery Center under local anestehsia with sedation (general anesthesia is not necessary). A surgical shoe is worn for 2 weeks and a sit down job can be resumed as soon as 4 days after surgery. The complications mostly involve entrapment of a nerve that runs across the bump (a few %) and not taking enough bone to make patients happy (~5%).

Dr. Zapf