Bone spurs can cause common foot pain

Published 10:14 pm Tuesday, December 30, 2008

“I get pain on the top of my foot whenever I wear shoes. What can I do?”



That’s a good question! As a matter of fact, the condition you probably have is really more common than you may imagine. And although (as with any symptom), there can be many causes, the most common reason for pain on the top of the foot (called the mid tarsal region) is the development of bone spurs. People with high arched feet (supination) are very predisposed to this condition. But it can also occur in patients who pronate (flatten or roll their feet in) excessively.

Abnormal motion (like pronation) causes friction on the small bones and joints in this area and they in turn react by forming bone spurs. These small spurs can often be felt directly under the skin in this area. Joint damage can also occur, producing changes similar to those seen with osteoarthritis.

Once the spurs become large enough, they begin to push the structures on top of them (tendons, blood vessels and nerves) up, while shoe pressure pushes these structures down. A tiny nerve in the area (dorsal intermediate cutaneous nerve — for those of you who want to impress your friends) becomes trapped and compressed. So in essence, a nerve entrapment syndrome develops.

Because of this, the symptoms may change from originally being achiness and soreness to signs of nerve irritation. This may include burning, tingling and numbness as well as sharp electric type pain that can stay localized or radiate down towards the toes or up towards the ankle. And to further complicate this condition, a bursa may form from the constant friction and pressure in the area. If this occurs, swelling may become evident on the top of the foot.

Because of the wide variety of symptoms that can occur with this condition, physicians who are unfamiliar with it may incorrectly make a diagnose of peripheral neuropathy, a far more significant problem often seen with Diabetes, vitamin deficiencies and other diseases. I have even seen gout diagnosed because of the severity of symptoms that can occur.

Treatment is rather simple in most cases, and it’s only rarely that the bone spurs need to be removed. Symptoms are again, due to the downward shoe pressure over this area. The direct cause of the pain is actually the tightening of your shoe laces directly over the bone spurs which in turn compresses the nerves in this area. So wearing a shoe that doesn’t press on this spot is obviously preferred.

But since avoiding a shoe that presses on this area is not always possible or practical, placing some adhesive foam under the tongue of your shoe will usually provide enough cushioning to eliminate the symptoms. Remember the skin in this area is very thin and doesn’t offer much protection.

If this doesn’t work, usually padding the tongue of the shoe on either side of the most painful area will usually do the trick. This will allow you to tie your shoes without any direct pressure on that tiny nerve or other sensitive structures.

At times an injection of cortisone directly under the skin may be necessary in conjunction with the foam padding. And when indicated, fully custom inserts to reduce the abnormal friction and pressure on the bones and joints can often prevent further problems.



—A former reconstructive foot and ankle surgeon and past clinical instructor of medicine at Emory University School of Medicine, Dr. Pack practices at MCG Medical Associates, Lake Oconee Village in Greensboro. He specializes in biomechanical structural analysis and works with patients who have arthritis and wish to decrease joint symptoms and remain active. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist and helps the UGA Golf Team (2005 NCAA National Champions). For further information please see his web site at www.drloupack.com or contact him directly at 706-454-0040.