Pain in the Top of the Foot
There are several causes of pain on the top of the foot. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient
Pain of sudden onset without the occurrence of injury on the top of the foot just behind the toes may be a stress fracture of a metatarsal bone. There is frequently swelling in the area and it is painful to the touch.
Another common area of pain occurs near the middle of the top of the foot, generally a bit to the outside of the foot. In this area of the foot the tendons that go to the toes can become inflamed. This is called extensor tendonitis. One cause of this condition is excessive tightness of the calf muscle. When the calf muscle is tight it places excessive stress on the tendons on the top of the foot that pull the foot upward and against the tightness of the calf muscles. Wearing a shoe with a one-inch heel will help to take the stress off of the tendons on the top of the foot. Aggressive stretching of the calf muscle is also very helpful. Oral anti-inflammatory medications can help. When 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 on the top of the foot.
More generalized pain on the top of the foot with swelling or a “thickness” to the foot may be caused by degenerative arthritis. This is seen in people with flatfeet or a slowly collapsing arch.
Another area of degenerative arthritis that causes pain on the top of the foot is in the area of the big toe joint. Jamming of the joint will cause bone spurring to occur on the top of the foot. Pressure from the shoe can cause pain. Treatment for these conditions consists of taking oral anti-inflammatory medications and functional foot orthotics. Surgery can be an option for the degenerative arthritis about the big toe joint but tends to be of limited value for the area of the mid foot.
Generalized pain in the top of the foot that occurs in children and young adults may be due to a condition call Tarsal Coalition. This pain tends to occur on the outside portion 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 a limitation in the person’s activity. Early diagnosis is made using x-rays and a MRI or CT scan. Treatment is with the use of functional orthotics and on occasion surgery. Early diagnosis and treatment is very important.
Pain can also occur on the top and inside of the foot. In people who are very active in sporting activities can develop pain in this area. The pain can be due to a stress fracture of one of the bones (Navicular bone) in this area. Diagnosis can sometimes be difficult. X-rays are generally negative and if a stress fracture is present the diagnosis may require a bone scan or MRI. Treatment consists of rest with a limitation of activity, oral anti-inflammatory medications, below the knee walking casts, functional orthotics or rarely surgical exploration of the area.
Yet another area of pain on the top of the foot is just below the ankle joint on the outside portion of the top of the foot. In this area of the foot there is a small fleshy area. This fleshy area is a small muscle called the Extensor Digitorum Brevis. Underneath the muscle there is a small canal between two bones. This area is called the Sinus Tarsi. In this area there are three small ligaments that can become inflamed. A common cause of this pain is due to a flattening of the foot, which pinches these small ligaments. Sometimes there is actual jamming of two bones causing the pain.
Treatment consists of stretching the calf muscles to reduce it effect of flattening the foot, oral anti-inflammatory medication, cortisone injections, functional orthotics and occasionally surgical exploration.