How to Get Rid of Pain on Top of the Foot

You can generally get rid of pain on the top of the foot by doing one or more of the following:

• Resting the foot and placing ice on it for between 15 to 20 minutes, 2 to 3 times daily
• Taking non-steroidal anti-inflammatory drugs, like Ibuprofen, to reduce pain and inflammation
• Wearing footwear that is roomy and also offers good support.
• Not tightening shoe laces so much, especially around the pain area
• If there's swelling, using a compression wrap
• Keeping the foot elevated above the heart level whenever you are at rest

In this article, we will explore this subject in detail, looking at the common causes of pain on the top of the foot and how these underlying causes can be effectively treated.

Anatomy of the Foot

To effectively discuss this topic, we must start by understanding the anatomy of the foot and how it works. 

Your foot is made up of 26 bones, 33 joints, over 100 muscles, tendons, and ligaments, as well as blood vessels and nerve network. Every piece works in precise tandem with the other to help you stand, walk, run, and jump efficiently. When a single piece goes out of alignment, it can immediately or eventually lead to pain.

The Bones

The bones of the foot are spread across three main regions - the forefoot, the midfoot, and the hindfoot.

·         Forefoot - The bones found here include the metatarsals (5 of them) and the 14 phalanges found in the toes.

·         Midfoot - Here we have the 3 cuneiform bones, the cuboid, and the navicular.

·         Hindfoot - The bones here include the talus and calcaneus

With regards to pain on the top of the feet, the bones usually involved are the metatarsals from the forefoot or the navicular and cuneiforms. The metatarsals are long bones that connect the toes to the midfoot, while the cuneiforms and navicular form the arch of the midfoot. Overuse and direct impact on these bones can result in bruising or stress fracture which will of course cause pain.

The Ligaments

These bones are held together by tough ligaments to ensure proper structure and stability. They can however be exposed to trauma which will result in sprain or tear. This will automatically present as pain on the top of the foot.

The Tendons

Aside from the bones and ligaments, there are the tendons that attach the muscles to the bones. At the top of the foot, the extensor tendons, comprising of the extensor digitorum longus and extensor hallucis longus, control actions like lifting of the foot and toes as you walk or run. These tendons stretch across the top of the foot and so can easily get inflamed in certain conditions, resulting in pain.

The Nerve Network

The nerve network provides sensation to the foot. In this case, we are looking at the dorsal foot nerve system, and it includes the Superficial Peroneal (Fibular) Nerve, which is the main nerve that supplies sensation to the top of the foot, and the Deep Peroneal (Fibular) Nerve which only supplies sensation to the web space between the big toe and the second toe. The Deep Peroneal (Fibular) Nerve also provides motor functions to the extensor muscles, facilitating the raising of the foot and toes.

If these nerves are compressed as a result of tightfitting footwear or swelling, they can get irritated and this can result in sharp pains or, in milder cases, tingling.

The Blood Vessels

Finally, blood vessels carry the blood through the feet, with the main vesse, in this case,l being the dorsalis pedis artery. While the dorsalis pedis artery may not directly be responsible for pain or discomfort, certain conditions, like swelling or trauma, can restrict its ability to efficiently supply blood. This can result in vascular symptoms and discomfort.

Common Causes of Pain on Top of Foot

Extensor Tendonitis

From our section on tendons above, you should be familiar with the extensor tendons. When these become inflamed, the condition is known as Extensor Tendonitis.

The inflammation of the extensor tendons can be caused by factors including: tight fitting footwear, repetitive stress like hiking or running, and overextension. When these tendons are inflamed, you may feel burning pain or aching on the top of the foot. This may come with some swelling and will usually get worse if you get the foot active.

Stress Fractures

When the foot is overused through high-impact activities like marathon, jumping, or suddenly increasing the intensity of your exercise etc., small fractures can be created in the metatarsal bones or the navicular. These fractures will usually result in sharp pains felt mostly around the areas of the fracture. They will also worsen when the foot is bearing weight and may come with some swelling.

Improper Footwear

Any footwear that is shallow, narrow, has really tight laces or straps, or pushes the top of the foot against the top of the shoe can cause irritation to the bones, tendons, and nerves. This includes high-heel shoes and they can all result in increased strain which will in turn lead to discomfort and pain.

Nerve Compression

Compression of the different branches of the dorsal foot nerve system can ensue due to tight-fitting shoes, trauma, or swelling. When this happens, you can experience sharp pains, burning sensation or tingling. This can sometimes come with numbness.

Midfoot Arthritis

This occurs when the small joints in the midfoot begin to degenerate or get inflamed. It happens most at the point where the tarsal bones connect with the metatarsal bones.

Common causes for this include wear and tear from use, osteoarthritis as a result of aging, rheumatoid arthritis, and post-traumatic arthritis. This condition results in stiffness in the mornings or after staying inactive for extended periods, some swelling around the midfoot, and a deep, aching pain on the top of the foot.

Gout/ Pseudogout

Similar to midfoot arthritis, these are also forms of inflammatory arthritis. For gout, it results from the sudden spiking of the levels of uric acid in the blood. This leads to the formation of urate crystals. These crystals, which are quite sharp, are formed in the joints, so they will easily be formed in the midfoot joints causing severe inflammation.

Pseudogout, which is also known as calcium pyrophosphate deposition disease, is similar to gout. However, instead of urate crystals, it involves the formation of calcium pyrophosphate crystals which also form in the joints.

In the two cases, severe inflammation ensues and this causes severe pain, warmth, redness, and swelling on the top of the foot. While gout can be traced back to dietary choices, pseudogout is often linked to metabolism and aging.

Structural Abnormalities

Anything that interferes with the biomechanics of the foot can result in pain on the top of the foot. Examples include flat feet, high arches, or even bone deformities, like tarsal coalition which is largely congenital.

For example, with high arches, pressure is increased on the extensor tendons and metatarsals, resulting in irritation or pain. In a case like tarsal coalition, two or more tarsal bones are fused, a condition that will result in restricted motion in the midfoot. This restriction will often lead to stiffness as well as increased strain on the ligaments, extensor tendons, and the top of the foot's bones. All of these will lead to sharp pain or aching and maybe some swelling.

How to Know the Cause of Pain on Top of Foot

It’s one thing to have a general knowledge of the causes of pain on the top of the foot but an entirely different thing to be able to determine what the cause may be in a specific situation. Being able to distinguish the cause in a given situation is key to proposing a treatment method that will be effective.

So, let’s quickly explain how you can go about identifying the cause of pain on the top of the foot in any given situation.

Identify the Exact Location of the Pain

The first thing to try to do is identify where the pain is located. This can give you a good idea of what is causing it.

In general, if the pain's location is specific and pinpoint, then it is likely an issue with a joint tissue or bone. If, however, it is broader and has a dull ache, then it is likely related to the tendons or soft tissue.

To check, use your fingers to press along the top of the foot.

Here's a guide:

 

When Do You Feel the Pain?

Next, check for when you feel the pain and if it increases during activities. Below is a guide:

 

Pain Characteristics

Aside from the location of the pain, its characteristics can also be an indicator of its root cause. Below is a guide:

 

Visual Inspection

Visual inspection plays an important role as it can further reveal clues that will help you narrow down the cause of the pain. Below is a guide:

 

Mobility Test

A mobility test will show if the movement of certain parts of your feet increases the pain.

Toe Raise Test – Raise your toes while keeping your heel down. If you feel pain across the top of your feet, then it may be caused by extensor tendonitis.

Single-leg Hop – While hopping on one leg, check for pain. If you feel a sharp pain on the top of your feet, then you may be dealing with stress fracture.

Shoe Pressure Test – Wear a tight-fitting shoe and see if the pain increases. If it does, then you may be dealing with nerve compression or just a bad-fitting shoe.

Check Known Risk Factors

There are known risk factors that can exacerbate pain on the top of the foot. Check for risk factors that may apply to you and the likely cause of pain as listed below:

 

Time to See a Doctor

The checks provided above are meant to act as a guide. However, it is possible that after carrying out these checks, you are still unable to isolate the cause. If this is the case, then it may just be time to visit your doctor.

It may be time to go for a proper examination at the doctor’s if any of the following applies to you:

·         You've rested for up to a week and the pain still persists

·         Your foot can not bear your weight so you can no longer walk well

·         The swelling or bruising increases

·         The feeling of numbness, tingling, and burning increases

·         You feel sudden and severe pain, often at night

A doctor will be able to carry out a detailed examination to determine what the cause of the pain could be. This examination may include x-rays, ultrasounds, MRI, and nerve conduction studies for when neuropathy is thought to be the likely cause.

Treating Pain on Top of Foot

Now that we know both the causes of pain on top of the foot and how to confirm which of the causes may be responsible in our case, we can begin to look at treatment options based on the cause.

Extensor Tendonitis

The goal here is to reduce the inflammation in the tendon so that further strain is reduced. To achieve this goal, do the following:

·         Stay off high-impact activities like running and hiking for about 1 to 2 weeks. This will give the tendons time to heal. Should the pain continue, try reducing the weight you place on the foot to the barest minimum.

·         Try applying an ice pack on the area for between 15 to 20 minutes as this can help reduce the pain and inflammation. Do this every 2 to 3 hours and be sure not to place the ice in direct contact with your skin.

·         Wear shoes that offer good support and have enough toe room so it does not put pressure on the tendons. It should neither be tight nor have high heels.

·         Take nonsteroidal anti-inflammatory drugs like Ibuprofen to reduce the inflammation and pain. Remember to follow the dosage instructions.

·         Do gentle toe stretches and exercises because they help improve strength and flexibility in the tendons. This has to be done only when the pain has subsided.

·         Get a therapist to provide guided exercises that can help restore the function of the tendon and also ensure that it does not reoccur.

·         Use orthotics as they can help prevent long-term recurrence, especially when it comes to providing support and reducing strain on the tendon.

Stress Fractures

The goal is to help the bone heal quickly and also prevent any further damage. Try the following:

·         Reduce all high-impact activities for between 6 to 12 weeks and gradually return when the bones are healed.

·         Keep the foot off-weight bearing for about 4 to 8 weeks. You can use crutches or walking boots.

·         Apply ice packs on the spot and also elevate the foot above your heart level to reduce the swelling.

·         Physical therapy can offer exercises that will strengthen the ankle, promoting the restoration of mobility.

·         Your diet should include an adequate supply of calcium and vitamin D to promote bone healing.

·         The use of orthotic insoles will be helpful, especially as a preventive measure.

Midfoot Arthritis

The goal of this treatment is to reduce the load on the joints and also bring the inflammation under control. To achieve this, do the following:

·         Take NSAIDs for the pain and to reduce the inflammation.

·         Wear supportive shoes with rigid soles to reduce motion in the joints.

·         Reduce your activity, especially on uneven terrain.

·         Use custom orthotics to provide stabilization for the midfoot and also reduce the pressure on it.

Gout or Pseudogout

This treatment aims to quickly reduce the inflammation and also prevent its reoccurrence. It involves the following:

·         Placing ice packs on the area and elevating the foot when at rest. Do this for between 15 to 20 minutes every 2 to 3 hours.

·         Dietary adjustments that will include drinking a lot of water, reducing the intake of red meat, shellfish, and alcohol which can increase uric acid levels (this is for gout).

·         Taking high doses of NSAIDs or corticosteroids to control the pain and inflammation. These have to be prescribed by a doctor. Medication like allopurinol or febuxostat that lowers uric acid levels may also be prescribed, especially for long-term care.

·         Resting the foot and avoiding undue stress to it, especially during an attack.

·         Wearing supportive footwear that will not put pressure on the joints.

Tight Shoes

The treatment here is to stop wearing tight-fitting shoes to reduce compression. Wear shoes with the following features:

·         Wide toe box

·         Lower instep pressure

·         Softer uppers

·         Low heels

·         For laceup shoes, use alternate lacing to allow you avoid the pain areas

You can use ice for immediate relief from inflammation. You should also avoid any stiff boots that put pressure on the midfoot.

Superficial or Deep Peroneal Nerve Compression

This treatment aims to reduce inflammation and decompress the nerves. This can be achieved by:

·         Getting rid of the source of the compression. Remove tight-fitting shoes, boots etc.

·         Taking anti-inflammatory medication like USAIDs

·         Applying ice therapy for about 15 to 20 minutes, especially where there's swelling.

·         Reducing stress on the foot by reducing activity that puts stress on it.

·         Employing physical therapy, using techniques like nerve gliding to improve mobility in the nerves.

·         Using insoles to help provide proper support and ensure that the foot's biomechanics operates optimally.

General Home Treatment for Pain on Top of Foot

In general, a lot of the treatments for pain on top of the foot, fall within a range which include:

·         The R.I.C.E protocol which stands for Rest, Ice, Compress, and Elevate. This protocol is effective in many cases of pain on the top of the foot.

·         Wearing supportive footwear that does not put undue pressure on any part of the foot.

·         The use of NSAIDs to manage pain and control inflammation.

·         Reducing high-impact activities so the condition is not worsened and healing hampered.

·         The use of orthotic insoles to promote proper foot biomechanics.

Pro Tip: Preventing Pain on Top of the Foot

Prevention, they say, is better than cure so to round off this article, we will give you this pro tip on preventing pain in the top of the foot in the future so you don’t have to worry about how to get rid of it.

The only way to prevent an occurrence of pain on the top of the foot, barring cases of accidental injuries, is to ensure that the foot’s natural mechanics are optimally supported, strain reduced, and pressure completely avoided. How can you achieve this?

·         Wear shoes that fit and offer enough toe box and soft uppers.

·         Warm up before engaging in high-impact activities. Slowly increase the intensity of your activity until you get it to where you want it.

·         Manage your weight so your feet don't have to carry excess weight.

·         Use Stride Soles' custom insoles to enjoy efficient weight and pressure distribution, shock absorption, optimal arch support, and the promotion of the foot's biomechanics. As long as you always use Stride Soles' custom-made orthotics, you drastically reduce your chances of having pain on the top of the foot or other foot conditions.