Why Does the Top of My Foot Hurt?

The feet are surprisingly complex and contain many bones, tendons, and muscles. Because they are also extremely active and responsible for running, walking, and standing, they are prone to injuries and conditions that often initially manifest as pain on top of one or both feet.

Extensor Tendonitis or Osteoarthritis

Because pain in the top of the foot is a potential symptom of many issues, it is important to consider coexisting symptoms to determine the cause. Swelling and stiffness that last for long periods or grating sensations when moving the foot often point to extensor tendonitis or osteoarthritis. These terms describe swelling in the tendon or the joints near the top of the foot.

Sinus Tarsi Syndrome

The sinus tarsi is the channel between the talus and calcaneus bones of the foot. Sinus tarsi syndrome describes pain, injury, or inflammation affecting this tunnel. It normally occurs due to significant overuse or after an injury like an ankle sprain. Sinus tarsi syndrome can cause pain in both the outside of the ankle and the top of the foot.

Metatarsal Issues

Within the foot, the metatarsal bones stretch from the tarsal bones to the phalanges. These long, thin bones are prone to injuries that often cause pain in the top of the foot. Depending on whether the injury is a stress fracture or sprain, a person may experience swelling, bruising, or intense pain. Often, exercise will trigger or worsen the sensation.

Ganglion Cyst

Ganglion cysts are benign growths that develop along the tendons or joints, particularly in the hands and feet. The cysts range from pea-sized to about an inch in diameter. Some may not even form a noticeable lump. However, even a small cyst can cause significant pain or discomfort if it places pressure on a nearby nerve.

Gout

One of the most common forms of arthritis, gout causes significant pain. While it usually affects the big toe, it can cause pain and swelling in almost any joint. Depending on what joint gout affects, the pain may radiate from the big toe along the top of the foot or be localized near the ankle. The skin usually becomes red, hot, and swollen.

Bone Spurs

Any location where bones meet is a potential area for bone spur growth. These bony projections usually develop as a result of osteoarthritis damage. Most people with bone spurs experience no symptoms and are never aware of them. However, if they develop in the joints of the feet, they can cause mild to severe pain along the top of the foot.

Peripheral Neuropathy

Neuropathies or peripheral neuropathies are nerve issues that cause pain, tingling, or muscle weakness. They often begin in the hands or feet, though they can affect any part of the body. Diabetes is the leading cause of neuropathy in the United States, but it may also result from trauma, medications, and various health conditions.

When to See a Doctor

A few key signs indicate that pain on the top of the foot is a symptom of a serious issue that needs medical attention. These include

• Severe pain that affects normal activities
• Pain that worsens or returns
• Pain that persists for several weeks
• Loss of sensation
• Faintness, dizziness, or feeling sick due to pain
• Snaping, grinding, or popping noise at the time of injury
• Foot undergoes shape change or has an unusual angle

Diagnosis

To determine the cause of the pain, doctors will perform a physical exam and enquire about when the pain began and what may have triggered it. If necessary, they will ask their patient to walk or roll the foot. When they suspect a fracture or similar issue, experts will order an X-ray or other imaging test.

Treatment

Because the feet must support the entire body, even a minor injury can quickly worsen. It is important to not overwork the foot during the recovery process. Physical therapy can help with peripheral neuropathy or extensor tendonitis. Casts and walking boots can assist with sprains and fractures. To combat the pain and inflammation, doctors recommend nonsteroidal anti-inflammatory drugs. For home treatment, rest the affected foot, and ice it for 20 minutes at a time.