Pain On Top Of Foot

The top of the foot is also known as the dorsal aspect of the foot and this describes the entire upper surface of the foot, running from the ankle to the toes. There are several important joints, tendons, nerves, blood vessels and muscles on the top of the foot that all interact with each other and due to the complex structure of the top of the foot, it is not uncommon for painful conditions to manifest in this area.

Additionally, there is very little protection on the top of the foot so the structures are some-what exposed and prone to impact injuries such as dropping a heavy or sharp object on your foot, for example. In this article I am going to explain the possible causes of pain on top of foot so you can understand more about your condition and decide on the best course of treatment to improve and/or eliminate your symptoms.


Pain On Top Of Foot Causes

Metatarsal Stress Fracture

A metatarsal stress fracture is a small hairline crack that can appear in the metatarsal bone (the long bones on the top of the foot) and is another common cause of pain on top of foot. It occurs due to repetitive strain and trauma to the metatarsals, which over-time leads to the development of a stress fracture. In many cases, this will occur on the outside of the foot, on the 5th metatarsal. In some circumstances, stress fractures can occur as a result of a single traumatic incident, but this tends to be a more severe fracture, rather than the hairline crack characteristic of a stress fracture. Strenuous activities such as intense training, sporting activities, collisions, falls, blows, twisting, unfavourable landing on the feet or wearing inappropriate footwear can all contribute to the development of a stress fracture.

You will likely notice swelling on the top of the foot and potentially severe pain in this region when a stress fracture is present. Generally, the best treatment for metatarsal stress fractures include limiting the movement in the foot through strapping and taping and a reduction in activity (minimizing the use of the feet) to allow the bones to recover. Full recovery typically takes around 6 weeks, but obviously this is variable from person to person and the location of the fracture. Fractures on the outmost metatarsal can take longer to heal and may even require surgical intervention.

Dorsal Compression Syndrome

This occurs when there is excessive flattening of the foot arch. The natural arch that we have in the foot is supposed to flatten slightly with every step we take, as a shock absorption mechanism. However, when the arch becomes excessively flattened for whatever reason, the bones on the top of the foot can become compressed together, leading to pressure and pain in the joints.

This can become a long-standing problem and the only way to properly treat this is by preventing the arch from flattening excessively. This is usually achieved by the use of orthotics/insoles and your Podiatrist can do a thorough assessment and design insoles or orthotics unique to your foot and prevent arch collapse and resolve the pain associated with dorsal compression syndrome.

Foot Tendonitis

The tendons of the foot have to pass round various joints and structures, as well as supporting the foot structure and function. Is it not uncommon for the foot tendons to become inflamed and painful when they are over-worked and over-used and this can lead to tendonitis. When the tendons are over-used they become damaged, with micro-tears appearing in their structure. This triggers the inflammatory response which causes the pain and discomfort.

Although this is most common in the posterior tibial tendon (more about that condition here) it can potentially occur in any of the foot tendons. As this condition is mainly associated with over-use, giving them time to recover is the most important part of the treatment process and this may involve reducing activity level duration and intensity. Ice can also be used after periods of activity to reduce the inflammation in the area. If the tendons are becoming strained as a result of faulty foot structure and mechanics such as fallen arches, you will need to see a Podiatrist to discuss how to rectify this.

Trapped Nerves

As there are many nerves and nerve endings in the foot, it is not uncommon for these to become trapped or pinched by a joint or by surrounding tissues such as muscles and tendons. When a nerve becomes trapped in this way, pain may be felt on the top of the foot as tingling, numbness or even a sharp stabbing pain that can remain local to the site of the entrapment or radiate down the entire nerve (felt as a shooting pain).

This can become very painful if not corrected and is likely to be caused by faulty foot mechanics and may even require surgery if the nerve is trapped in a structure such as the tarsal tunnel. Perhaps the most common nerve entrapment in the foot is between the third and fourth metatarsal heads, causing pain in the region of the third and fourth toes. This is known as Morton’s Neuroma and you can read more about that condition here.

Superficial Phlebitis

This is the inflammation of the superficial (close to the surface) veins on the top of the foot. Although this condition can actually occur anywhere that veins are exposed on the skin surface. Usually this occurs due to direct trauma to the nerve itself and therefore it is no surprise that this can lead to pain on top of foot as the nerves on the top of the foot are very exposed and liable to trauma.

The trauma leads to inflammation of the vein and the area can become swollen and painful, and the veins may appear like ‘spider veins’ on the foot. The condition is rarely serious and usually resolves with time and the use of anti-inflammatory medications can speed up this process. If this condition has occurred without any recollection of damage or trauma to the area, this may be an underlying sign of a circulatory disorder and should be checked by a medical professional.

Ganglion Cyst

As one of the most common causes of pain on top of foot, the ganglion cyst is a small, fluid-filled sac that is ‘lump-like’ in appearance and tends to occur over the area of a joint or tendon. On the top of the foot this is most common near the ankle. The exact cause of the cyst itself is unknown and although painless in itself, the cyst can put pressure on the underlying tissues such as nerves, which can trigger considerable pain.

Usually the cyst will naturally resolve and the best course of treatment is to accommodate the lesion until it resolves, by changing footwear, for example. If the cyst does not resolve, it can be treated by a minor surgical procedure that involves puncturing the cyst and draining the fluid.

These are the most common causes of the pain on top of foot and I hope you will know understand more about your condition. Various other conditions such as gout or fibromyalgia may also lead to top of foot pain and you may wish to read more about these conditions by visiting the pages provided. If you are still unsure about the causes of your foot pain I advise visiting your Podiatrist or Physician.