Your feet are complex structures with 28 bones, 19 muscles, 107 ligaments and numerous tendons. If you have pain on the top of the foot that lasts more than a week or interferes with walking or other activities, it’s important to get a medical diagnosis.
Some common causes of pain on the top of the foot include overuse injuries and health conditions like gout. Other less-frequent causes include tarsal coalition and ganglion cysts.
Stress fractures
Stress fractures are one of the most common causes of pain on the top of the foot. They occur when you repeatedly put too much pressure on a bone, typically over a long period of time (like training for a marathon or standing at work all day). They often start as a small ache and then get worse. Eventually, the bone can break, or crack all the way through.
The boat-shaped navicular bone in the middle of your foot takes on lots of stress during exercise, making it susceptible to this type of injury. Your healthcare provider will use a physical exam and imaging tests to diagnose the problem. They’ll ask questions about the severity of your pain, how it relates to activity level and whether you have any bruising.
X-rays can help identify stress fractures, but if you’re an athlete who has a high risk of them, your provider may recommend the Sonosite Edge ultrasound system, which provides more precise images without radiation exposure. You might also need to avoid the activity that triggered your pain and switch to low-impact exercises, wear a walking boot or use a custom orthotic to reduce pressure on the injured bone.
Structural issues within your feet can also cause pain on the top of your foot, including flat feet and arthritis. You might also experience pain from toe deformities, like hammer, claw and mallet toes.
Extensor tendonitis
Extensor tendonitis is a condition that affects the tendons that run along the top of the foot and ankle. These tendons attach to muscles that lift the foot and toes upward with each step, so they are particularly vulnerable to friction and repetitive stress. This condition can develop if you exercise or participate in activities for prolonged periods of time, change your workout routine abruptly, or increase the amount of running or jumping you do. Wearing improper footwear and not stretching or cooling down after a workout can also aggravate your symptoms.
The first step in treating this condition is getting an accurate diagnosis. An orthopedic specialist will perform a physical examination and review your symptoms, medical history, and lifestyle to determine the cause of the pain. They will also examine the affected area to look for signs of swelling or redness. They may order X-rays or an MRI to see if there is damage to the tendons.
Once your doctor has diagnosed you with this condition, they will prescribe treatments that aim to reduce inflammation, alleviate pain, and restore normal function to the affected foot or hand. Treatment options include ice packs, a change in your exercise regimen, using assistive devices, and physical therapy. In severe cases, surgery may be necessary. It is important to follow the recommended treatment plan to prevent complications and maintain a quality of life.
Hallux rigidus
Hallux rigidus (stiff big toe) is the most common arthritic condition of the big toe joint. It occurs when the protective cartilage that cushions the big toe joint begins to break down, restricting movement of the toe. This can lead to pain while walking, especially when putting pressure on the bump that forms in the middle of the big toe bone, the first metatarsophalangeal, or MTP, joint.
Most cases of hallux rigidus develop naturally and do not have any obvious cause. Over time, normal wear and tear on the MTP joint can cause damage that leads to the formation of bone spurs. A foot and ankle surgeon can diagnose the condition with a physical exam. They will test how much the MTP joint can bend and look for evidence of bone spurs.
Several treatment options can relieve pain and improve the function of the MTP joint. Nonsurgical treatments include pain relievers and anti-inflammatory medications. Your doctor may recommend shoe inserts to help minimize the amount of pressure on the MTP joint. Taping the big toe or using shoes with a stiff sole or a rocker bottom can also decrease pain and prevent the problem from getting worse.
Surgery is a last resort but may be necessary if nonsurgical treatments do not work. A procedure called cheilectomy involves removing the bony bump and a portion of the big toe bone so the toe can bend more easily. Another option is arthrodesis, which involves fusing the bones in the MTP joint together. During this procedure, your doctor will remove the damaged cartilage and use pins, screws or a plate to join the bones in the MTP joint.
Gout
Gout is an inflammatory condition that can cause pain on the top of the foot. It’s caused by excess uric acid in the body. Uric acid is a natural byproduct of the breakdown of foods and drinks like red meat, shellfish, sugary snacks, alcohol (especially beer) and some medications. Gout patients typically experience a sudden onset of pain, swelling and tenderness in the affected joint.
The diagnosis is usually made based on the patient’s history of symptoms and a physical exam. A rheumatologist may also order imaging tests to identify the uric acid crystals in joint fluid. These are often visible in x-rays, ultrasound, magnetic resonance imaging and dual-energy computerized tomography. A rheumatologist can also remove joint fluid and examine it under a microscope to see the crystals.
The treatment for gout is aimed at treating current symptoms and preventing future flares. Anti-inflammatory medication, such as NSAIDs, and a drug that helps the body excrete uric acid, called colchicine, help reduce inflammation and pain. In severe cases, a podiatrist might inject cortisone into the affected joint. Other strategies include diet and lifestyle changes, such as avoiding red meat and alcoholic beverages, and weight management. Gout left unchecked can lead to permanent joint damage and chronic pain.