The humped tarsus is characterized by a "bump" type deformation at the neck of the foot. Dr Julien Lopez tells you how it can be managed.
The humped tarsus of the foot corresponds to a dorsal prominence of the tarsus bones interfering with the footwear.
The tarsus characterizes the posterior region of the foot skeleton.
It is composed of the 7 bones of the foot:
- The talus, the only bone that articulates with the bones of the leg, tibia and fibula.
- The calcaneus, which forms the heel and is the largest and strongest bone of the foot.
- The cuboid bone, a bone of cubic shape located towards the lateral face.
- The navicular bone, a flat boat-shaped bone located towards the medial face.
- The three cuneiform bones.
This deformation is related to a bony hypertrophy of the bony circumference of the joint between the 1st cuneiform and the base of the 1st metatarsal. It is usually aggravated by an excessive camber of the foot. The bump thus formed will come to rub against the shoe. A tissue shell (or hygroma) will develop to protect the foot from friction.
This malformation can then swell and become inflammatory and painful.
In case of humped tarsus, several causes can be mentioned:
- A patient with hollow foot is more likely to develop a deformation of the tarsus due to the camber of the foot.
- Osteoarthritis of the tarsal joints is also an aggravating factor. The wear of the articular cartilage will cause the formation of bone outgrowths.
In case of lumpy tarsus, several symptoms may appear:
- A rubbing of the swelling with the shoe causing inflammation and severe pain.
- Irritation of the nerves on the top of the foot causing sensations of electric shock and loss of sensitivity.
- Tendinitis of extensor tendons including the long extensor tendon of hallux
- A difficulty to put on some shoes.
Doctor Julien Lopez will be able to prescribe additional tests to confirm the diagnosis of painful lumpy tarsus.
A medical imaging assessment is required:
- Pictures of the 2 feet in charge can identify the importance of hollow foot, deformation and search for a cuneo-metatarsal osteoarthritis with dorsal osteophytes
- Ultrasound can identify the consistency of hygroma.
- Additional studies may also be prescribed on a case-by-case basis (MRI, CT, NM).
In the case of humped tarsus, non-surgical treatment is the first-line treatment.
Doctor Julien Lopez can prescribe:
- The use of oral painkillers and anti-inflammatory medications to effectively relieve pain.
- Wearing orthopedic soles to support the arch.
- A dressing to protect the top of the foot from friction.
- Corticosteroid infiltration and hygroma puncture to reduce inflammation.
If the medical treatment does not sufficiently relieve the symptoms of the humped tarsus, an operation can be proposed by the surgeon.
The operation of the humped tarsus is usually performed as an outpatient. The patient will be able to return to his home only a few hours after the end of the operation.
The preoperative appointment with the anesthesiologist is mandatory.
The procedure is usually performed under regional anesthesia.
Humpback tarsus surgery consists of shaving the dorsal prominence of the tarsus.
2 surgical approaches exist:
Percutaneous surgery is usually preferred by the surgeon since it has fewer disadvantages than conventional surgery: reduced scar size, faster recovery, lower risk of infection… This technique removes bone conflict.
The procedure is performed using a 2mm incision at the joint to perform the removal of the bone surplus. The surgeon who specializes in the operation of the humped tarsus of the foot is identified using an imaging system.
Conventional or “open” surgery is more invasive than percutaneous surgery. It allows to overcome bone conflict but also to realize the removal of hygroma.
Once the procedure is complete, Doctor Julien Lopez will give you the steps to follow for a good recovery.
The operated foot should be rested for 15 days after the operation although walking is possible (if no pain).
It is also advisable to freeze the area operated, several times a day to limit post-operative swelling.
Sick leave after a humped tarsus operation is between 2 and 4 weeks.