Pain top of 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.
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The anatomy of the foot is complex. There are multiple nerves, arteries, bones, ligaments and tendons.
The action of walking involves the following actions: The first is heel strike, then foot flat to the surface, followed by heel lift and finally toe off. Any change in this sequence will lead to mechanical dysfunction and pain over time.
The foot consists of 22 bones covered with cartilage, acting independently with adjacent bones. The foot is divided into three sections: the forefoot (ball of the foot and toes), the mid-foot, and finally the hind foot.
This entire complex is connected by many ligaments and muscles.
The most common condition causing pain in the top of the foot is probably osteoarthritis developing in the mid-foot. Osteoarthritis is a disease characterized by abnormal cartilage metabolism that leads to cartilage loss, inflammation of the joint, and the development of bony spurs. A patient will complain of pain in the top of the foot. They won’t be able to wear shoes that put pressure on the top of the foot. On examination, bony spurs can be palpated. There may be signs of local inflammation.
Conservative management consists of the application of topical non-steroidal anti-inflammatory preparations and avoidance of footwear that puts pressure on the affected area. While injections of glucocorticoid (‘cortisone”) may provide temporary relief, in general, the results are not satisfactory.
Recently, the needle tenotomy using ultrasound guidance to remove the spurs, followed by injection of platelet-rich plasma has appeared to be effective for a number of patients. Surgery is usually not recommended. In rare cases, fusion may be needed.
Gout is another form of arthritis that affects the top of the foot. Here, local steroid injection followed by anti-inflammatory medicines or colchicine to break the acute attack and uric-acid lowering therapies to treat the chronic condition is advised. Pseudogout can also affect the foot and must be differentiated from gout because the treatment is different.
Rheumatoid arthritis is a common cause of pain in the top of the foot. The treatment here is local steroid injection and systemic control of the disease.
Bursitis and tendonitis can also cause pain in the top of the foot. The treatment hinges on an accurate diagnosis. While most of these problems will respond to local glucocorticoid injection, physical therapy, and rest, some require the use of needle tenotomy and platelet-rich plasma.
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