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 a stress fracture of a metatarsal bone. There is usually swelling in the area and it is painful to the touch.

Another type of pain occurs near the middle of the top of the foot and. In this region of the foot the tendons that lead to the toes can become inflamed. This is called extensor tendonitis.

A major cause of this condition is excessive tightness of the calf muscles. When the calf muscles are tight they place excessive stress on the tendons on the top of the foot that pull the foot upward and counteract the calf muscles. Wearing a shoe with a one-inch heel will help relieve the stress on the tendons.

Aggressive stretching of the calf muscle is also very helpful. Anti-inflammatory medications can help. If these measures do not work, a functional orthotic should be tried. The orthotic corrects the alignment of the foot taking the stress off of the tendons.

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 or a slowly collapsing arch.

Another area where degenerative arthritis can cause pain on the top of the foot is in the big toe joint. Here, bone spurring occurs on the top of the foot. 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.

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

The pain tends to occur 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 portion of the foot. It can be hereditary. It tends to get worse with activity. If not treated in its early stages it can cause significant arthritis in the foot causing limitation in activity. Early diagnosis is made using x-rays and a MRI scan.

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

Pain can also occur on the top and inside of the foot. In people who participate in sports, a stress fracture of the navicular bone can occur. Diagnosis is often difficult. X-rays are generally negative and the diagnosis may require a bone scan or MRI. Treatment consists of rest with limitation of activity, anti-inflammatory medications, a below the knee walking cast, functional orthotics, and rarely surgery.

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. There is a small canal between two the talus (upper ankle bone) and the calcaneus (heel bone). This canal is called the sinus tarsi. In this area there are three small ligaments that can become inflamed. Patients with flat feet often pinch these ligaments. Treatment consists of stretching the calf muscles to reduce it effect of flattening the foot, 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 indicate a strain of the interosseous muscles.

The interosseous muscles lie between the toes, and help stabilize the foot in walking and running. When they are strained, they often cause sharp pains on the top of the foot or beneath it. The pain from this injury is often confused with a neuroma of the foot (inflammation of a nerve in the foot) that causes similar sharp pains.

This injury and this type of pain may be brought on by fatigue of the foot muscles through excessive standing or running activities. Other causes include a blow to the foot, a fall, excessively tight shoes, very high heels, or walking barefoot on a foot that needs a shoe for support.

Interosseus muscle injuries can occur between several metatarsals at once. Although rarely identified by health professionals, strains of these muscles are common. To identify this injury, one only needs to gently squeeze the metatarsals together. This usually reproduces the pain sensation.


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

• Tendonitis, the irritation of a muscle tendon, the rope-like muscle that attaches to the bone, can cause top of foot pain.

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

• 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 foot pain.

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

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