These bone growths on the top of the feet are often associated with functional overpronation.

As the feet roll inwards, the bones in the arch lower hitting the limit of their range of motion. The repetitive impact causes inflammation and eventually new bone growth to form. If the cause is not treated the growth will ultimately limit the range of motion and give rise to significant discomfort.

As the growth becomes more pronounced any pressure on this bony growth (exostosis) from shallow footwear or tight laces can produce excruciating pain.

Attempts to improve the foot’s functional control using custom orthotic devices can compound the issue making the shoe feel slightly tighter and thus more pressure. This is why a lengthy discussion is required when navigating choices in footwear and custom functional orthotic design.

One simple way to navigate this situation involves the use of footwear with laces.

In the first case this morning the patient’s shoes were tied so loosely that she was in danger of falling or at best sliding within the shoes.

By slipping the shoe on the foot we were able to identify the exact location of the bump relative to the offending laces. Then with a quick re-lacing, skipping the offending area enabled the firm closure of the shoe for stability but removed the pressure completely.( To see how click here)

The second case of dorsal exostosis of the morning had similar functional stability issues causing classic patterns of callous formation, ingrown toenails and yes! a bump at the base of the metatarsal attached to the big toe. Unfortunately, his orthotic combined with his brand new Blundstone safety boots as you can see in the image are clearly going to cause problems.

The seam joining the leather panels was causing a sharp impression in the skin overlying the bump. While not excruciating at this point it will rapidly progress in that direction. Fortunately, we were able to reduce the bulk of his orthotic sufficiently. Due to the nature of his occupation safety footwear is a permanent fixture in his future so a lace-up boot will be on his shopping list.

Quick note on the world traveled Blundstone boot line. They “come from the land down under” in fact Tasmania, but back a few years ago i believe some or all of their manufacturing was out sourced else where. While not an uncommon practice it was accompanied by and brand-wide decrease in depth of the boot midfoot. I personally have worn the non-safety version for years and following this change found my very necessary orthotic unbearable with thick winter socks. So great stable boots just watch for the fit on the top of your arch when fitting a custom orthotic.

Where all of our efforts are unsuccessful or were employed too late, then surgical reduction is a great option for the exostosis. The important thing to remember is that once surgically removed that material will grow back very rapidly if the functional control is not maintained.

So you know the usual matra! First get the source identified and managed, if performed correctly this should get rid of the pain and prevent further development.

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