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A bone spur on the top of the foot can be very painful. Even wearing shoes that press on the top of the foot can be painful. The pain can limit your day-to-day activities. There are some things that you can do to reduce foot pain associated with a bone spur on the top of your foot.
For the purpose of this article, we will be discussing treatment for bone spurs of the midfoot.
Let’s dive in…
Anatomy of the Midfoot
The midfoot consists of the tarsometatarsal joints (the articulation between the metatarsal bones and the cuneiform bones/cuboid bone), and the naviculocuneiform joints.
The purpose of the midfoot bones is to connect the rearfoot to the forefoot. The bones are held together by strong ligaments.
The Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal. The tibialis anterior tendon courses along the inside of the midfoot. The extensor tendons course along the top of the midfoot. The peroneal tendons course along the outer portion of the foot.
The deep peroneal nerve and branches of the superficial peroneal nerve course along the top of the midfoot.
What Causes Bone Spurs on the Top of the Foot?
Bone spurs on the top of the foot are often caused by degenerative changes secondary to osteoarthritis. Due to a lack of cartilage along the joint surfaces, the body builds up excess bone to try to repair the area, resulting in spurring.
Many people who have arthritis on the top of the foot also suffer from arthritis elsewhere in the body such as their knees.
Bone spurs can also be caused by post-traumatic arthritis.
Say for instance you played soccer when you were younger and fractured your cuneiform or metatarsal base. Post-traumatic arthritis could occur and create spurring of the joints.
Bone spurs can also be caused by auto-immune diseases such as rheumatoid arthritis and inflammatory arthritis such as Charcot arthropathy.
Bone spurs in the midfoot can also occur secondarily after undergoing a rearfoot fusion surgery. When a joint in the rearfoot is fused (such as a subtalar joint), it is not uncommon to see arthritis form years later in the adjacent joint due to the transfer of stress and pressure in the midfoot.
What Does a Foot Spur Feel Like on the Top of the Foot?
- Dull, achy pain on the top of the foot
- Pain during walking and rest
- Pain while walking on uneven surfaces or walking up the stairs
- Sharp tingling/burning pain on the top of the foot
- Pain when wearing shoes that press on the top of the foot
- Stiffness in the joints of the midfoot
How Are Bone Spurs on the Top of the Foot Diagnosed?
If you have a painful bone spur on the top of your foot, you should visit your local foot doctor. Your doctor will perform a history and physical exam.
Your doctor will palpate the different joints in the foot to localize where exactly your pain is. Most people with painful bone spurs on the midfoot have pain in the 1st-3rd metatarsocuneiform joints.
Your doctor will order x-rays of the foot to examine the midfoot joints. Your doctor will be looking for narrowing of the joint surfaces as well as spurring.
If the joint spaces are not clearly visible, your doctor may choose to order an MRI. An MRI can confirm the presence of arthritis in the foot, and also help rule out fractures and tendon injury.
When people have bone spurs, many people experience burning and tingling pain in the nerves that cross over the spur. The spurring can irritate the nerves on the top of the foot.
Your doctor will tap on the individual nerves on the top of your foot to determine whether you experience tingling/burning pain going into your toes. This is a “Tinel’s test”, and can identify presence of nerve compression/damage.
How Do You Treat a Bone Spur on the Top of the Foot?
Non-surgical Treatment for Bone Spurs on the Top of the Foot
Pain associated with bone spurs can be treated with RICE therapy and NSAIDs. This can help reduce pain and inflammation at the midfoot.
Voltaren 1% gel is a fairly inexpensive topical NSAID gel that you can rub onto your foot. It helps reduce dull, achy pain associated with arthritis. You can buy it on Amazon.
If you are experiencing mostly nerve pain on the top of your foot, you can try obtaining Lidocaine 4% patches and applying them on the top of your feet. You can wear them on your feet for up to 12 hours. They will help make the top of your foot numb.
Orthotics can be beneficial in reducing pain associated with a bone spur. Orthotics can help redistribute pressure away from the midfoot, and also helps reduce shock at the midfoot joints.
Custom orthotics are ideal because they would be custom-made for your feet. You can visit your local foot doctor to have your feet molded to obtain custom inserts. Custom inserts last much longer than over-the-counter inserts.
Custom inserts can last 5-10 years, versus over the counter inserts that usually last 6 months to 1 year. In many cases, custom orthotics may be covered by your insurance. It’s best to call your insurance company to check to see if they are covered. Custom orthotic prices can range from $400-$800.
A carbon fiber plate can also be beneficial in reducing pressure and relieving shock in the midfoot. It’s essentially a stiff plate that you place into your shoes (underneath your shoe liner). It makes the bottom of the shoe stiff and prevents excess motion in the painful midfoot joints. You can buy it here on Amazon.
Corticosteroid injections can be immensely beneficial in reducing pain associated with bone spurs on the top of the foot. Your foot doctor will inject a steroid into the midfoot and this can help reduce pain and inflammation. Generally, injections for arthritis can help relieve midfoot pain for up to 3-6 months.
Surgical Treatment for Bone Spurs on the Top of the Foot
When conservative treatment fails, surgery may be needed to reduce pain associated with a bone spur on the top of the foot.
If you are experiencing pain from the bone spur, and have minimal arthritis in the joints, your doctor may recommend simply shaving off the painful bone spurs. This can be done under anesthesia in the operating room.
Afterwards, you can walk partial weight-bearing in a surgical shoe for up to 4-6 weeks after surgery before transitioning into an athletic shoe.
However, in some cases, extensive arthritis of the midfoot joints may be present. If this is the case, your doctor will recommend removing the bone spurs and fusing the midfoot joints. Fusing the midfoot joints helps prevent motion in the joints, thus reducing pain.
This procedure is more involved and would be a more lengthy recovery. Your doctor will perform the surgery under anesthesia in the operating room. He/she will use plates/screws/stapes to fuse the midfoot joints.
You will need to remain off of your feet for 6-8 weeks minimum in a cast boot/splint to allow for the bones to properly fuse. This would be followed by gradual weight bearing in a cast boot for 4 weeks before transitioning into an athletic shoe.
Some of the complications of midfoot surgery include inadequate wound healing, nerve damage, nonunion, irritation of hardware, and infection.
Surgery for bone spurs can be done by a Podiatrist or an Orthopedic Surgeon.
Conclusion
In conclusion, painful bone spurs on the top of the foot should not be ignored. There are many things that you can do to relieve midfoot pain. In some cases, surgery may be needed if conservative therapy fails. It’s best to speak to your local foot doctor about your options.
Related articles: Simple Solutions to Manage Arthritis on the Foot
Do you have a painful bone spur on the top of your foot? What has helped to reduce your pain in the area? I’d love to hear your thoughts! Leave a comment below!
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References
- Kurup H, Vasukutty N. Midfoot arthritis- current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):399-405. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211829/
- Thomas MJ, Peat G, Rathod T, Marshall M, Moore A, Menz HB, Roddy E. The epidemiology of symptomatic midfoot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot. Arthritis Res Ther. 2015 Jul 13;17(1):178.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499901/
- Harish Kurup, Nijil Vasukutty, Midfoot arthritis- current concepts review, Journal of Clinical Orthopaedics and Trauma, Volume 11, Issue 3, 2020, Pages 399-405. https://www.sciencedirect.com/science/article/abs/pii/S0976566220300837
- Rao S, Baumhauer JF, Becica L, Nawoczenski DA. Shoe inserts alter plantar loading and function in patients with midfoot arthritis. J Orthop Sports Phys Ther. 2009 Jul;39(7):522-31.https://pubmed.ncbi.nlm.nih.gov/19574663/
- Bawa V, Fallat LM, Kish JP. Surgical Outcomes for Resection of the Dorsal Exostosis of the Metatarsocuneiform Joints. J Foot Ankle Surg. 2016 May-Jun;55(3):496-9.
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