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Posted By Robyn Hughes, ND


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February 23, 2021
Julie Nazar

What’s your advice on how to treat a bone spur that’s on the top of the foot?

February 23, 2021
Natural Footgear

Hi, Julie,

Thank you for your question—it’s a really good one. Some foot docs approach this problem in the following way:

They apply a topical local anesthetic over the bone spur in question and cover it with plastic wrap, leaving this setup in place for about 45 minutes. Then, the doc will ask the patient to do an activity that would normally cause pain in the area of the bone spur. If the topical local anesthetic eliminates the pain, it’s likely that the patient has neuritis/neuralgia from the spur irritating their nerve, in which case lacing strategies (e.g., skip technique) can be employed, along with precise shoe stretching. It’s very important in this scenario to avoid any footwear-related pressure on the affected area, at least until the nerve calms down.

If the topical local anesthetic does not eliminate the pain, it’s likely that the pain is related to osteoarthritis, and the patient may benefit from surgical excision of the bone spur, or a selective fusion procedure. Interestingly, bone spurs that occur on the top of the foot are often associated with a big toe that is out of alignment, which creates aberrant loading of the tarsometatarsal joints and, later, osteoarthritis. For this reason, foot-healthy footwear is necessary to permit realignment of the big toe. One sign that there may be significant osteoarthritis present is if there is foot pain when the tarsometatarsal joints are twisted. Radiographs will often provide a lot of helpful information as well.

I hope this info helps, Julie! Please let us know if you have any follow-up questions.

All the best,
Robyn Hughes, ND

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