FOOT BUMP ON TOP OF THE FOOT

Welcome to ‘Foot bump on top of foot – foot pain series 3

Thanks for clicking onto my blog on the foot bump. No pressure, no sale, just pure open honest information. The blog was written after one of my regular readers asked for information about her foot bump. I decided to check out what readers might find on the internet. As usual the U.S YouTube tops the polls with information while the traditional UK sources were disappointing. However how good is the YouTube material really? For readers wanting academic resources on this subject go to the end of the article where Clinician Portal is headed.

In this article I will look at:

  • a Google search for what people have said
  • formal critique of the advice given
  • the cause (known as aetiology -Br. etiology – US)
  • some of the features that are involved with the condition
  • how you can help yourself and a few pointers about surgery
  • Clinician Portal evidence

More information if needed.

For those with an interest for deeper knowledge you can click on the link at the end of this article as it is a great resource. A couple of recent academic papers (2016-17) from a podiatry and orthopaedic source provide an academic approach surgery?


The condition

A condition that causes pressure on top of the foot due to changes around the middle bones also know as the tarsus.

Conditions associated with the bump include joint surface damage (arthrosis). Tendon or nerve pain that arise with the hard bone bump. Look at the picture of a female foot to identify with the problem (source: Bawa 2016) .

Naming the condition Other names given to this condition are dorsal spur, exostosis, tarsal boss. This latter term is quite apt as in the Collins dictionary boss can mean a knob or stud or other circular rounded protuberance.


Checking out what has been written on the internet

Google search came up with the following. I liked this for its short punchy statements but I have removed some of the other material not relevant.

Lump on top of your foot?

If you’ve noticed a lump on the top of your foot, you most likely did a quick assessment, perhaps considering such questions as:

  • Is it painful?
  • Is it soft or hard?
  • Is it a different colour than other foot skin?
  • Have you had a recent injury to the area?

We do need to look at hard and soft. The colour over the skin can also help. If very red and inflamed this means the body is reacting to the site. Is pain increasing or not helped by pain killers, then seek help. If you have had an injury ask a professional for help. Looking at Google again this statement is true but it does not mean you have arthritis which is a medical condition. You may have elements of what we now call arthrosis; wear and tear only and it can be quite minor but hurts of there is inflammation present.

Bone spurs can occur in any bone, but they’re most common in the joints. They’re often caused by joint damage associated with osteoarthritis. Damage caused by regular stress or pressure placed on a bone for a long period of time.

Typical question from a layperson (edited)

(Qu. 1) ‘I have a small pain in the top of my foot just below my toes. I get a sharp pain in the centre of the foot, that is well I can’t move for just a matter of seconds. It happens if I move my foot wrong, but I’m not sure how to explain that. It feels like being punched. The pain in the right foot, makes walking uncomfortable, however especially now that the weather has gotten warmer I will be doing more walking. I walked last night for over an hour. My foot is sore today, however I still can get up and walk around my office as needed. Any suggestions or thoughts. Thank you so much.’

(Ans.1) ‘You could try icing it when it bothers you. Maybe go to a massage therapist.’

(Ans.2) ‘I have one too! Sometimes, if it gets bothered by a shoe or too much walking, I just spend some time off the foot or put some ice on it. Hope that helps!’

(Ans.3) ‘There is not a lot that can be done for this non surgically, as it is a bony mass. Try wearing loose fitting shoes as tight shoes would tend to aggravate it. Also consider placing a pad on top of the deformity to help reduce stress and strain on the area with the compression that causes the irritation of the nerve.’

 

 

An online medical doctor (US) responds as well, so this must be good?

‘Hello, make sure the shoes are wide in the toe and have good heal support. Use Spenco insoles which you can get in any shoe store. These are ultra thin but absorb over 90% of any impact. This might or might not be just in the feet, so when you can afford it you need to see a podiatrist or a physical medicine and rehabilitation specialist to see where the actual focus of strain is…I prefer the later because even a lower spine problem can affect the feet and cause pain. And vica versa.

On line can be helpful but it is difficult of genuine help actually fails to understand the problem.’


Feedback

Good or bad advice?

Well the information while helpful can be misleading but there are some good bits worth highlighting

The patient

The person writing in gives us a hint. Sharp pain with shoes. Foot movement causes discomfort and the level of pain is described as ‘punched’. Walking is uncomfortable and sore and she is likely to use the foot more as it becomes warmer.

One key piece of evidence could relate to a nerve that is irritated. The pain is momentary and stops her moving. What of advice 1? Ice is always helpful but will only settle discomfort due to inflammation if it is minor. If it is nerve pain, ice will play a minor role.

The answers

Answer 2. About the same and the idea of reducing walking is only a temporary measure. Answer 3 sounds more intuitive. Footwear loosening is good and I like the pad. So it’s time to look out a YouTube video. Oops there aren’t any! The YouTube is full of promoting practice visits and you don’t want to do this unless you need to. The person giving answer 3 is taking a view that sometime surgery is required. This is true but getting that diagnosis right is vital.

But what about the doctor. He must know as he is a medical doctor?

It is okay to talk about shoes and make them wide. Sounds fair advice, but why not focus on design of the top of the shoe? This is where the problem lies

‘…Use Spenco insoles which you can get in any shoe store. These are ultra thin but absorb over 90% of any impact...’

 Oh dear someone is not understanding the problem. Put an insole in the shoe, even if it is ultra thin and you will make the shoe tight and the bump will hurt more! Okay, if in doubt avoid the question entirely doctor, but I like your advice about seeing a podiatrist. Hey now why chuck spine in there, that is scare mongering!

Conclusion

Sometimes medical doctors do not know as much about feet as you might think, let alone hope that they do. It’s true as many of my GP doctor friends admit this. On line can be helpful but it is difficult where that help, even if well meaning  fails to address the problem. Some of the lay ideas on the other hand were reasonable. Patient’s own experience or journeys can be enlightening and deal with practical solutions.


Heredity

Some people have the bump, others do not so there is a hereditary feature in its appearance. My mother and I do not have one, my father and sister do. My wife does not have one but one daughter does.

The first anyone knows about the bump is from a shoe which inevitably rubs. Some consider the bump due to a high arch foot, but this is not an exclusive club. Some consider that at point there is movement during walking of the two bones that are involved in the joint.

 Whatever happens bone spurs stick up and can irritate a nerve, or the skin becomes red and sore. A small sac of fluid (bursa) can forms and this is often called a ganglion. A balloon like appearance arises which when pressed and feels spongy.

Use a bible?

Some say hit it with a bible; this would NOT BE a good idea. Hitting the foot may cause deep bruising or even a bone fracture. The idea was to burst the lining so the fluid, which is a clear gel like substance would be released.The lining of the ganglion is very active and can reform and certainly even if removed can reoccur. However, a bump may not be that simple.

The following conditions can be considered

  • Arthrosis, or joint surface damage.
  • Tendon pain, often associated with overuse
  • Nerve pain
  • Ganglion
  • Bursa
  • Hard bone bump also known as a spur.
  • Gout has been recorded but this is not that common in the midfoot so it can be set at a lower priority.

First of all, look at the appearance. The top of the foot will have a bump above the arch and it can be tender to touch, worse in some shoes. If we look at an x-ray it is easier to see what is happening. Picture: Dr Van Dalen

The main aim is to take away pressure so it comes down to shoe selection and what you can do to the shoe to make matters more comfortable. Remember that the lacings of shoes can be too tight, or the cut of the shoe places a  too much pressure where it is tender.


  Self-help remedy

 

Protect the skin from pressure. This was recommended by layperson’s number 3 answer.

  • Use a felt pad with cavity over the bump and if this works the pad can be converted so that it sticks onto the skin or inside the shoe under the tongue.
  • Select shoes that have a lower heel so that the arch does not bend as the joint will open more in high heel shoes.
  • The quarters (where the laces run through the eyelets) should not be closed up too tightly and a cushioned tongue in a shoes will be better tolerated (see picture c/o www.footeducation.com)
  • You can make your own soft tongue using an adhesive dressing as in a cavity type pad fashioned from a square felt or foam. See self help sheet (click here)

In general, local protection and selection of footwear to avoid pressure over the bump will allow the area to settle. Unfortunately, if you have the shape which will not go away then you are going to have to compromise. This can be tough for those who like fashion.


Seeking surgery

Not perhaps where you want to go but sometimes surgery is the best way to resolve matters permanently. You should seek out a foot surgeon (podiatric or orthopaedic). Check they are registered with the HCPC or GMC. Here’s a summary of my own experience and some of the things that I would tell a patient before surgery.

Surgery

  • The scar line is important so where the skin is cut can be a problem.

  • The bone is shaved down. If you are under 20 there is a chance that reoccurrence can arise because young people can regenerate bone. This might happen more readily if there is greater movement after surgery as it can all start again, or insufficient bone is removed.

  • Although bump surgery can be very effective, wounds can take time to heal. You can expect skin to heal from 10-21 days before it is relatively strong to get back into shoes. Sensations may vary after surgery, numbness or local sensitivity.

  • The good news is that the surgery works and it is effective.

  • The bad news is that the joint may be less stable and if you have existing degeneration in the joint movement made by making the joint freer may worsen matters. This means a second surgery to stiffen and fix the problem. This does not happen very often.

Stiffening the toe?
 This means that a screw or metal brace (plate) is placed across the joint. On balance real problems arise from loss of movement around the joint  from this procedure.

So why do I need to have it stiffened?
The spur actually holds the joint stable. As the surgery involves shaving off the spur the two ends might now move. After surgery, and once the foot has healed you can start to try out shoes again. It makes sense to allow up to six months for all shoes. Of course there might be a pair you still cannot use but on the whole you comfort and the original problem will have disappeared.


ConsultingFootPain (Footlocker) is a website published by Busypencilcase Communications Ltd that offers impartial information about foot health and common foot problems without promotion of products other than resources that might be best suited. English is the main language but information sources may come from all over the world.  The opinions expressed in articles are that of the editor while selection of material is provided that appears equally impartial, direct and likely to be helpful to any reader while attempting to provide a balance of argument. Providing responsible self help guidance is the guiding principle

 

Thanks for reading ‘Bump on top of the foot’ written by David Tollafield. Published 14 October 2019. Busypencilcase Communication Ltd.