Introduction
The dorsal midfoot exostosis is a noticeable, frequently uncomfortable bulge on the top of the foot. The bulge, which is frequently noticeable, is caused by bony growth on top of the arch, which is medically referred to as the metatarsal-cuneiform joint.
What Is Exostosis?
A bony protrusion known as an exostosis can develop anywhere on the body. This condition, also known as a bone spur, develops when a bony growth protrudes above the surface of the bone. These calcium-based bony growths can develop in any area of the body. It is known as a saddle bone malformation and occurs most frequently in the heel. An alternative name for it is metatarsal cuneiform exostosis, referred to as the protrusion of bone that develops over the arch on the top of the foot. The first metatarsal cuneiform joint's excessive movement or mobility might lead to the development of this condition. In an effort to reduce the joint's movement, bone growth takes place. The onset and severity of pain will increase gradually.
What Are the Causes of Dorsal Foot Exostosis?
The causes of dorsal foot exostosis are:
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Supinated (high-arch) feet are more likely to develop this ailment than over-pronated (rolled-in) feet.
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The overpronated foot frequently has weak foot mechanics. The first metatarsal tends to move about excessively, which might irritate the metatarsal-cuneiform joint and lead to bony growth.
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The first metatarsal in the supinated foot has a steeper degree of inclination toward the ground, which can make the base of the metatarsal stand out at the top of the foot.
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Long-term irritation to the area, such as that brought on by tight footwear, inflammation, and trauma, are other causes of dorsal midfoot exostosis.
What Are the Signs and Symptoms of Dorsal Foot Exostosis?
The common signs and symptoms of dorsal foot exostosis are:
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A raised, firm hump on the arch of the foot indicates dorsal midfoot exostosis. The development of bone is not painful in and of itself; rather, the difficulties brought on by the bony expansion are typically painful.
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The bony protrusion makes it difficult for sufferers to wear certain shoes. In general, open-toed shoes do not create any issues, but enclosed shoes can compress and rub against the bony protrusion, often causing pain, redness, and swelling.
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Beyond the bump itself, compression and rubbing can exacerbate nearby nerves in addition to the bump itself. Aching, tingling, and pins and needles sensations are frequently felt in the top of the foot and the toes as a result of irritation to these nerves.
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In more severe situations, pain may also be felt even if the bone growth is not directly irritated. This frequently manifests as a severe aching ache, commonly following weight-bearing exercise.
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Compression of the medial dorsal cutaneous nerve (nerve supplying certain areas of the foot and leg) across the area may cause paresthesias (abnormal prickling or burning sensation), tingling, and numbness. Almost always, the metatarsocuneiform joint is crossed by the medial dorsal cutaneous nerve.
What Are the Investigations Done in Dorsal Foot Exostosis?
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Sensory Testing: Nerve involvement may be detected through sensory testing, particularly in the dorsal first web space.
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X-Ray: The dorsal prominence will be seen on a lateral X-ray, and the dorsal hypermobility may cause a plantar gap in the metatarsocuneiform joint (a joint in the foot).
How Is Dorsal Foot Exostosis Classified?
The different types of dorsal foot exostosis are:
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Type 1: Localized dorsal exostosis.
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Type 2: Dorsal exostosis combined with joint osteoarthritis.
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Type 3: An angular deformity and dorsal exostosis.
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Type 4: Exostosis bridges other metatarsocuneiform joints.
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Type 5: Pseudoexostosis of the anterior pes cavus' dorsal humping.
How Is Dorsal Foot Exostosis Managed?
1. Conservative Treatment: One or more of the therapies might be:
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Footwear Modifications: Modifications to footwear and padding can be highly beneficial since they relieve direct bump irritation and ease compressive forces.
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Orthotic Therapy: This can assist in addressing the underlying issues, such as excessive pronation and high-arched feet.
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Advice About Footwear: Wearing the right shoes is important. Finding comfortable shoes that do not irritate the bump can be challenging for many people.
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Nonsteroidal Anti-inflammatory Medicines (NSAIDs): NSAIDs such as Ibuprofen, Naproxen, or Aspirin will reduce pain and swelling when used as directed by a doctor.
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Injection Therapy: This can ease joint and nerve-related problems alike.
2. Surgical Treatment: Surgical intervention may be necessary in situations where conservative therapy is ineffective. The midfoot exostectomy procedure, which involves surgically removing the hump, may be beneficial if there are no symptoms of underlying arthritis. Pain can stay the same or occasionally go worse if there is any arthritis and the lump is just removed. A surgical alternative may be suggested in this situation.
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Midfoot Exostectomy: Surgery is typically advised if one is in pain, limited or disabled, and having trouble getting into shoes despite wearing sensible shoes. Patients will be awake during the procedure because a local anesthetic is typically used. On the day of the procedure, patients can eat normally and take their regularly prescribed medications. Injections are used to inject the local anesthetic near the exostosis and the ankle. Compared to a dental injection, most patients find this to be more comfortable.
An injection behind the knee may occasionally be recommended. The procedure lasts roughly an hour; however, people should plan on spending about four to five hours in the day surgery unit. This gives the time to recover from the procedure while the doctor provides any necessary discharge instructions and packs. For the first day and night after surgery, patients must have a responsible adult at home for their safety.
What Benefits Can Surgery Provide?
The advantages of surgical treatment are:
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To lessen discomfort and a noticeable bone deformity.
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To enhance the comfort and fit of the footwear.
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The procedure is localized.
What Are the Complications of the Surgery?
Everyone should already have received the pre-operative information leaflet, which describes the general risks of foot surgery. Additionally, this technique carries the following particular risks:
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Numbness on the top of the foot due to nerve injury.
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Persistent discomfort in the underlying joint.
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The bump coming back.
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Stiff joints.
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An improper procedure.
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Joint pain due to arthritis.
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Sensitivity to scars.
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Persistent swell.
Conclusion
In conclusion, bony protrusions can be found on the top of the foot in a condition known as dorsal foot exostosis. It might be painful and uncomfortable, which would limit someone's movement and quality of life. Conservative methods including rest, pain medication, and shoe modifications are among the treatment possibilities, but in more severe circumstances, surgery to remove the bone growths may be necessary. It is advised to see a healthcare provider for a precise diagnosis and suitable treatment choices if it appears that one may have dorsal foot exostosis.
