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
