Tingling, burning, shooting sensations to the top of the foot. Pain is worse in shoes, especially lace ups. Hitting the nail on the head in describing your symptoms? This condition hurts! And it is making it next to impossible to find shoes that don’t make it worse! Help!
Dorsal neuritis is impingement of the nerve branches providing sensation to the top of the foot. When the dorsal sensory nerve branches get compressed, the top of the foot can experience a range of annoying sensations including those feeling like the top of your foot is being stabbed with a sharp object, a hot poker or tingling like you laid on it wrong.
To understand this condition and what could cause such a thing, it is first important to understand the anatomy of it all. The main nerve branches that supply sensation to the top of the foot are the medial dorsal cutaneous nerve and the intermediate dorsal cutaneous nerve. The medial dorsal cutaneous nerve innervates the top inside part of the foot and the intermediate dorsal cutaneous nerve innervates the top outside part of the foot. Any type of pressure on these nerves can, over time, cause discomfort.
There are several things that can cause pressure to the dorsal cutaneous nerves. Most commonly, the simple pressure from shoes that bind of the top of the foot can bring on these symptoms. People with a high arch foot type, known as a cavus foot, most commonly experienced this type of occurrence. Simply loosening the top of the shoe by skipping the laces in the area of discomfort, or wearing a shoe that does not bind the top of the foot, can do a great deal to relieve this cause of neuritis.
Dorsal neuritis can also be seen in the presence of any space occupying lesion. A dorsal exostosis (a bone spur on the top of the foot) can put pressure on these nerves as well. Besides the simple alteration of shoes, padding and some physical therapy, little else can be done with this type of neuritis causing condition, as the cause of the condition is within the bone structure. Surgical for reduction of the exostosis in this case is recommended when conservative therapy is insufficient to relieve pain.
Another space occupying lesion that can put pressure on the dorsal nerves is in the form of a cyst. These fluid filled herniations of typically either joint capsule or tendon sleeves can also put pressure depending on their size and location. When these fluid filled sacks are soft enough, they can be aspirated and injected with cortisone to help them shrink. If the cyst has been present for some time and has hardened, aspiration/injection becomes much less successful given the thickness of the fluid. Again, in the cases when alteration to shoes, padding and/or physical therapy is unsuccessful in relieving the discomfort, surgical excision of the cystic lesion is recommended.
If you are experiencing dorsal neuritis, please do not hesitate to contact our office and make an appointment. We look forward to helping you beat this annoying pain!