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DORSAL FOOT PAIN/EXOSTOSIS

Dorsal foot pain (top of the foot) occurs where the 1st metatarsal joint meets the cuneiform joint or at the 1st metatarsal phalangeal joint. There is pain on the top of the foot that occurs in the morning and as the day progresses, more so the longer one is on their feet. When it is at the metatarsal phalangeal joint, it causes hallux limitus or hallux rigidis.

This can be an acute or chronic condition. Pronating feet as well as high arches that are falling can lead to narrowing at the joint space. It can eventually create a bony enlargement (exostosis) as the foot tries to adapt to the stress through osteoarthritic changes.

Other names or similar foot conditions:

• Hypermobile first ray
• Hallux limitus or rigidis

Symptoms:

• Pain at joint
• Loss of ROM at joint
• Bony growth at joint

Signs to look for:

• Pronating feet
• High arches
• Tight calf muscles
• Bony growth at joint

Possible Causes:

• Overpronation
• High arches
• Tight calf muscles

Goals:

• Support arches
• Correct motion of foot while walking
• Reduce pressure and friction on the toes
• Modify shoes to accommodate exostosis

Solutions:

Arch Supports:

• Bio-Orthotics Winstep or Sundance exercising support with metatarsal lift

• Lower and thinner arch support with longitudinal and metatarsal support, such as the Bio-Orthotics Journey or Silhouette, for use when shoes cannot accommodate the Winstep or Sundance exercising support

• Extra depth shoes with firm heel counter, connecting shanks, and stiff rocker soles
• Shoes with stretchable uppers
• For exercise, wear shoes with titanium springs
• MBT physiological shoe
• Negative heel shoe
• Go barefoot on a minimal basis only

Activities:

• Avoidance of high impact exercising until symptoms abate
• Rotate weight bearing exercises, such as walking or jogging, with non-weight bearing exercising, such as swimming or bicycling