Pain in the top of the foot

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are several causes of pain on the top of the foot. The type and location of the pain help determine the cause of the pain.

Pain of sudden onset on the top of the foot just behind the toes, without a history of trauma, may be due to a stress fracture of a metatarsal bone. There is usually swelling in the area and it is painful to the touch. weight-bearing increases pain. A history of prolonged walking before the symptoms began may be present.

Another type of pain occurs at the top of the mid-foot and toes. The tendons that lead to the toes can become inflamed. This is called extensor tendonitis.

A possible cause of this condition is excessive tightness of the calf muscles. Tight calf muscles place stress on the tendons on the top of the foot. Trauma and tight shoes can also cause the problem. Wearing a shoe with a one-inch heel will help relieve the stress on the tendons.

Calf muscle stretching is also helpful. Anti-inflammatory medications can help. If these measures do not work, a functional orthotic should be used.

Another cause of pain on the top of the foot is osteoarthritis. This causes a bony swelling. Osteoarthritis is often seen in people with flatfeet. The spurs from osteoarthritis irritate the deep peroneal nerve.

Another area where degenerative arthritis can cause pain on the top of the foot is in the big toe joint. Pressure from a shoe can cause pain. Treatment for this condition consists of anti-inflammatory medication and functional foot orthotics. Surgery can be an option for degenerative arthritis of the big toe joint.

Pain in the top of the foot that occurs in children and young adults may be due to tarsal coalition.

The pain occurs on the outside part of the top of the foot. A tarsal coalition is the abnormal fusion of two or more bones in the mid-foot. It can be hereditary. It tends to get worse with activity. It can cause significant arthritis in the foot. Early diagnosis is made using x-rays and a MRI scan.

Treatment involves the use of orthotics. Sometimes surgery is required. Early diagnosis and treatment is important.

Gout is a metabolic disease that can cause sudden attacks of pain across the top of the foot. There is intense inflammation. The condition is due to deposits of monosodium urate in the joints and soft tissues. Diagnosis is based on clinical grounds. Aspiration of an inflamed joint with identification of uric acids crystals cements the diagnosis. Excellent medicines are available for the treatment.

Another type of pain on the top of the foot is found just below the ankle joint on the outside part of the top of the foot. This pain is called the sinus tarsi syndrome. Patients with flat feet are at increased risk. Treatment consists of stretching the calf muscles, anti-inflammatory medication, cortisone injections, functional orthotics and rarely, surgery.

Sciatic pain usually starts in the buttocks and extends down the rear of the thigh and lower leg to the sole of the foot and along the outer side of the lower leg to the top of the foot. Pain may also be present in the lower back.

Sharp pains felt between the metatarsal bones of the feet can be due to strain of the interosseous muscles.

The interosseous muscles are situated between the toes, and help stabilize the foot in walking and running. Sharp pains on the top of the foot can be present. The pain from this injury is often confused with a neuroma of the foot (inflammation of a nerve in the foot) that can cause similar sharp pains.

This injury and this type of pain may be brought on by excessive walking or running. Other causes include trauma, a fall, excessively tight shoes, high heels, or walking barefoot on a foot that needs a shoe for support.

Other causes of pain in the top of the foot are:

• Ganglions, sacs of jelly-like fluid that develop after a leak in the joint capsule, can form on the top of the foot, and can also cause top of foot pain. This is relatively rare.

• Morton’s neuroma, an inflammation of the common digital nerve between adjacent toes on the bottom of the foot, can sometimes cause top of foot pain.

• Hammertoes, a condition that causes the toes to bend so that the tip of the toe is pointed down can lead to top of the toe joint pain.

A sprained foot and other more severe conditions can also result in top of foot pain.

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