What is Dorsal Midfoot Exostosis?

Dorsal midfoot exostosis is a distinct, often painful bump on the top of the foot. The bump is often prominent and is the result of bony growth that occurs on top of the arch, clinically known as the metatarso-cuneiform joint.

Signs and Symptoms of Dorsal Midfoot Exostosis

Dorsal midfoot exostosis is visually distinguished by a raised hard bump on the top surface of the arch of the foot. The bone buildup itself is not uncomfortable; rather, the complications caused by the bony growth are usually painful.Due to the bony prominence, sufferers often experience difficulty wearing particular shoes. Open-toed shoes generally pose no problem, but enclosed shoes can cause the bony prominence to compress and rub against the top of the shoe, often resulting in pain, redness and swelling.Beyond the direct irritation to the bump, compression and rubbing can also aggravate nerves located in the same area. Irritation to these nerves may cause aching, tingling, and pins and needles sensations often felt in the top of your foot and toes.In advanced cases, pain may also be experienced even without direct irritation to the bony growth. This is often felt as a deep aching pain and usually after weight-bearing activity.

Causes of Dorsal Midfoot Exostosis

This condition most commonly occurs in over-pronated (rolled-in) feet, but can also occur in the supinated (high-arch) foot.In the over-pronated foot, poor foot mechanics are often present. The first metatarsal tends to have too much mobility, which can cause bony irritation to the metatarso-cuneiform joint possibly resulting in a bony growth.In the supinated foot, the first metatarsal points towards the ground at a higher angle, which can cause the base of the metatarsal to be prominent at the top of the foot.Other causes of dorsal midfoot exostosis include long-term irritation to the area, such as that caused by tight footwear, injury and trauma.

Conservative Treatment

Our team at OnePointHealth will first perform a detailed assessment in order find the causative factors. With this information, we can develop a specific plan aimed to reduce the pain and discomfort, reduce the risk of further bony growth. Some of the treatments may include:
  • Padding and footwear modifications: These can be very helpful as they address the direct irritation to the bump and reduce any compressive pressures.
  • Orthotic therapy: This can help address the underlying causes such as over-pronated and high arch feet.
  • Footwear advice: Suitable footwear is very important. People often have difficulty finding shoes that do not irritate the bump, whilst still being comfortable to wear. Don’t worry, we have many years of combined footwear knowledge, so we’ll recommend you the right shoes.
  • Anti-inflammatory medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen, Naproxen, or Aspirin, will help with pain and swelling as per GP instructions.
  • Injection Therapy: This can provide relief to both the nerve and joint related pains.

Surgery for Dorsal Midfoot Exostosis 

In cases that are non-responsive to conservative treatment, surgical intervention may be required.