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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Bony Tops Of Feet Have Very Sensitive Nerve, Whole Top Of Feet Swollen. Causes ?

The boney tops of my feet have very sensitive nerve areas almost dead center on both feet worse on the right foot which has a bunion . just the slightest brush of a finger across the spot causes ridiculous pain for about a year now on and off... recently I had a bug bite on the inside of one toe which was driving me nuts so i tried to itch it with my left heel and hit that painful top of my right foot, now the whole top of the foot is bruised and swollen. Did I break a blood vessel? And if so what would cause them to be so easily damaged?
Mon, 25 Nov 2013
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Podiatrist,  's  Response
If the area on top of your foot is bruised, then yes, you have broken a blood vessel. The area of the foot that you are asking about is likely at the base of the first metatarsal at the first metatarsal cuneiform joint. This joint frequently develops bone spurs on the the top, particularly in the presence of a bunion deformity. Often this is asymptomatic, but if oriented just right, or better said, just wrong, then the bone spurs may impinge on either one of two nerves that cross right at that area (the deep peroneal and the medial dorsomedial cutaneous nerves. See figure: http://www.jaaos.org/content/13/3/186/F4.large.jpg). Also right in that immediate area is an artery (dorsalis pedis) and vein. All of these structures run over the sharp ridge caused by the bone spurs making them very vulnerable to injury, particularly from shoes that press too hard, pinching these neurovascular structures against the bone spurs.

As for how I treat this issue, I start by preventing any pressure to the sensitive area; make sure that your shoes are properly fit and that there are no seams or creases pressing against the bone spurs. If you are wearing laced up shoes, skip the lacing crossing that area to prevent the nerves from getting crushed. If this fails, I'll usually get x-rays to evaluate and sometime do a cortisone injection. But unfortunately if the pain fails to improve with these simple treatments, it may require surgery to remove the bone spurs and, on some occasions, the nerve if it has been too severely damaged.
Dr David Bernstein
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Bony Tops Of Feet Have Very Sensitive Nerve, Whole Top Of Feet Swollen. Causes ?

If the area on top of your foot is bruised, then yes, you have broken a blood vessel. The area of the foot that you are asking about is likely at the base of the first metatarsal at the first metatarsal cuneiform joint. This joint frequently develops bone spurs on the the top, particularly in the presence of a bunion deformity. Often this is asymptomatic, but if oriented just right, or better said, just wrong, then the bone spurs may impinge on either one of two nerves that cross right at that area (the deep peroneal and the medial dorsomedial cutaneous nerves. See figure: http://www.jaaos.org/content/13/3/186/F4.large.jpg). Also right in that immediate area is an artery (dorsalis pedis) and vein. All of these structures run over the sharp ridge caused by the bone spurs making them very vulnerable to injury, particularly from shoes that press too hard, pinching these neurovascular structures against the bone spurs. As for how I treat this issue, I start by preventing any pressure to the sensitive area; make sure that your shoes are properly fit and that there are no seams or creases pressing against the bone spurs. If you are wearing laced up shoes, skip the lacing crossing that area to prevent the nerves from getting crushed. If this fails, I ll usually get x-rays to evaluate and sometime do a cortisone injection. But unfortunately if the pain fails to improve with these simple treatments, it may require surgery to remove the bone spurs and, on some occasions, the nerve if it has been too severely damaged. Dr David Bernstein