The enlarged bone can cause pain directly from rubbing or compression against shoes. It can also irritate nerves in the area, leading to pain, tingling or pins and needles sensations in the top of the foot and toes.

When a deformity causes persistent pain or limits daily activities, surgical intervention may be needed. Your St. Cloud podiatrist will help you understand your options and determine the best course of action for you.

Symptoms

Occasionally, people will develop a bony protrusion on the top of their foot called dorsal metatarsal cuneiform exostosis or saddle bone deformity. This is a form of osteocartilaginous exostosis which involves cartilage and bone growth typically at the end of long bones. This condition can be painful and limit a person’s movement. In some cases conservative methods such as rest, pain medication and shoe modification may help, but surgery to remove the bone growths might be needed.

The raised, hard bump that characterizes dorsal midfoot exostosis is not painful in and of itself, but complications resulting from the bone buildup often are. For example, the prominence can make it difficult to wear certain shoes, particularly enclosed ones. This is because the shoes compress and rub against the bony prominence, causing pain, redness and swelling. The compression and rubbing can also irritate nearby nerves, leading to aching, tingling or pins and needles sensations felt on the top of the foot and in the toes.

In children with a saddle bone deformity, pediatric orthopedists have unique techniques for treating these conditions that can include the use of braces and manipulations of the bones and joints in order to realign the feet. This can be important for preserving the integrity of the growth plate, which allows children to continue to grow and develop normally.

Diagnosis

Children with rare foot and ankle deformities require special expertise to diagnose, treat and manage. Fortunately, many of these conditions can be treated successfully with non-surgical methods, including bracing, serial casting and orthotic devices. When necessary, surgery to realign the bone and straighten the toe can be performed.

Saddle bone deformity is an enlargement of the dorsum of the foot at the base of the first metatarsal and medial cuneiform joint due to osteoproliferation. It can result in pain from shoe pressure and the formation of a bursitis over the area. It can also cause difficulty in activities that require rigid footwear, such as ice hockey and skating.

X-rays can confirm the presence of this condition. The x-rays show the prominence of the base of the first metatarsal in relation to the cuneiform bone. On a lateral x-ray there is a plantar gap in the metatarsocuneiform joint and there may be bony proliferation over the first web space. Occasionally the medial dorsal cutaneous nerve, which crosses the first web space, is involved and this can cause paresthesias (abnormal tingling or numbness) over this region of the foot.

If the condition is not corrected early on it can lead to a progressive and severe arthritic change. It is very important to see a specialist in pediatric foot and ankle care, who can provide an appropriate management plan that includes non-surgical treatment if possible, followed by surgical correction as necessary.

Treatment

The human foot is a complex structure comprising 26 bones, 33 joints and more than 100 muscles, tendons and ligaments. When abnormalities occur in the foot and ankle, they can have a serious impact on mobility and overall quality of life. Saddle bone deformity is one of these conditions. Known more formally as metatarsal cuneiform exostosis, saddle bone deformity is a bony protrusion that develops over the arch of the foot on the top of the first metatarsal. It results from hypermobility in the first metatarsal cuneiform joint, which leads to excessive bone growth as the body tries to limit the movement.

This condition can be painful and may lead to complications such as a pinched nerve that causes pain, tingling, and numbness in the toes and lower leg. Conservative treatment options include avoiding direct pressure to the bump (exostosis) by wearing open shoes, and using padding that prevents shoe compression of the area.

Surgical options for rare and complex foot deformities are highly individualized based on the patient’s unique needs, diagnosis, and symptoms. Our board-certified podiatric surgeons are experts in the diagnosis and treatment of these conditions and will work with you or your child to find a treatment plan that is best for you. This can include orthotic devices, serial casting, physical therapy, and/or surgery.

Prevention

You ask a lot of your feet—they support you during daily activities like walking, running and biking. So, it’s important to take care of them and prevent foot conditions that may cause pain or interfere with normal walking.

A saddle bone deformity (also called a metatarsal cuneiform exostosis) is an enlargement of the area on the top of the foot at the base of the 1st metatarsal and the medial cuneiform bones creating a humping or bump. This condition can be painful if it is compressed from shoe pressure. The most effective way to manage this problem is to avoid closed in shoes and go barefoot as much as possible. The other option is to stick a pad of either adhesive felt or poron underneath the tongue of your shoe at the spot of the enlarged joint and bone. This can alleviate the pain from direct shoe pressure for short to medium term relief.

Other treatment options include anti-inflammatory medications and icing of the affected area. For more serious conditions such as cavus deformity, orthopedists may use a combination of a heel lift and arch insert to help even out the foot’s weight distribution, releasing tight ligaments and transferring tendons to rebalance and supplement weak muscles. For children with clubfoot, a surgeon using the Ponseti technique can correct the deformity and prevent future complications.