Looking down at your feet can sometimes be surprising especially when there are new lumps and bumps to be seen. The inner side of the foot which we will call the medial column has many important structures that are necessary for proper foot function. Unfortunately these structures also endure a high amount of stress and strain. With this increased stress, problems can develop such as bunions, arthritis, bone deformations, and swelling.
Bunions, also known as hallux valgus, is an issue with the 1st metatarsal of the foot. The 1 st metatarsal is the innermost long bone of the foot that is mainly responsible for maintaining the arch and also propelling the foot forward during the gait cycle. When this bone becomes strained it moves inward and the head of the bone protrudes on the inside of the foot behind the big toe. This bump can be very painful not only because of the increased pressure from the deformity but also the shoe gear pressing on the bump. Women usually complain of this pathology more often that their male counterparts because their shoes are much tighter around the bunion. The great toe will also start to drift to the outside of the foot thus accentuating the bump on the inside of the foot.
The next most common bump on the inside of the foot is due to arthritis of the 1st big toe joint. Whenever a joint becomes arthritic extra bone develops around the joint causing the motion to be limited. This boney prominence is usually see on the inside and the top of the big toe joint. Pain will occur with the lifting motion of the great toe since it is being inhibited by the arthritic extra bone. The cause of this problem is typically caused by trauma to the big toe joint. Athletes will commonly injure there big toe since jamming of that joint occurs commonly in high impact sports.
The next boney prominence that is sometimes visible is the navicular bone. The navicular bone is one of the bones of the midfoot and is connected to the posterior tibial tendon. The PT tendon is responsible for maintaining the medial arch of the foot. When this tendon begins to fail the patient will develop something called posterior tibial tendon dysfunction or PTTD. PTTD can occur naturally through life but obesity is a major factor for the falling arch. When the arch falls the PT tendon works harder to maintain the arch. This increased pull on the navicular bone causes the bone to increase in size in the direction of the pull of the tendon. A bump will form as a result of the increased navicular bone.
All of these pathologies can be helped with both conservative and surgical intervention. Conservative measures such as orthotics, padding, strappings, bracings, and injections, help to alleviate pain and also slow down the progression of the deformity. If conservative methods fail then surgical intervention may be necessary. Surgery on the various lumps and bumps differ greatly and are chosen based on symptoms and clinical findings.