Pain On Top of Foot

Author: Chloe Wilson - BSc(Hons) Physiotherapy

Find out about the 10 most common causes of pain on top of the foot

Pain on top of the foot can really affect our daily lives, affecting activities like walking, running and simply standing.  Our feet are one of the hardest worked parts of our bodies – with each step, a force of 1.5 times body weight goes through the foot. 

It comes as no surprise that approximately 75% of Americans have foot pain at some point in their lives. There are a number of causes of top of foot pain. There may be an injury to one of the foot bones, a problem in the soft tissues or the pain may be referred from further up the leg or from the lower back.

Causes of Pain On Top Of The Foot

Here we will go through a brief overview of the ten most common causes, looking at the symptoms and treatment options for each type of pain on top of foot.  To find out more about each one, use the relevant links below.

The most common cause of sudden top of foot pain without a specific injury

Common sites of foot stress fractures

What Is It: A small break in one of the foot bones, commonly one of the metatarsals

Causes: Repetitive overloading of the foot e.g. jumping, kicking and running especially if there is muscle weakness and tightness or a sudden increase in activity levels

Symptoms: Pain on top of foot which can be quite severe.  Tender to touch and swelling around the area

Treatment Options: Rest (you may need crutches to keep the weight off your foot for a couple of weeks), ice, ankle/foot brace, medication and occasionally surgery

Find out more about how to treat and prevent this common cause of top of foot pain in the Stress Fractures section.

Tendonitis, inflammation of the foot tendons, can cause pain

What Is It: Irritation and inflammation of the tendons on the top of the foot

Causes: Shoes that are too tight, calf tightness, spending long periods on your feet, altered foot biomechanics, walking/running on uneven surfaces or simply dropping a heavy object on your foot

Symptoms: Gradual onset of swelling, bruising and pain on top of foot.  Tender to touch and may be uncomfortable wearing shoes

Treatment Options: Change how you lace your shoes, use orthotics, rest, ice the foot, employ ultrasound, get a course of injections or stretch the calf muscles

Find out more about how to abolish the pain in top of foot and prevent the problem from recurring in the Extensor Tendonitis section

This more uncommon foot problem tends to cause localised pain around the top of the foot towards the outside of the ankle

Sinus Tarsi Syndrome causes pain on top of the foot

What Is It: Inflammation and irritation around the Sinus Tarsi, a small channel between the ankle and heel bone that ligaments, blood vessels and nerves pass through

Causes: It most commonly occurs due to instability, often the result of an ankle sprain. It can also be caused by poor foot biomechanics, or repetitive activities such as ballet and baseball

Symptoms: Foot pain on top and outside of the ankle which gets better with rest and worse with activity. Ankle stiffness in the morning which eases with movement. Instability and tenderness to touch

Treatment Options: Ice, exercises, joint mobilisations, stability training.  Complete rest from all aggravating activities is vital

Visit the Sinus Tarsi Syndrome section to find out more about how to treat this common cause of pain on top of foot.

These are the most common cause of top of foot pain affecting the toes.

What Are They: Deformities in the toes affecting the positions of the small toe bones

Claw Toe results in the toe sitting in an abnormal position

Causes: Poor fitting footwear is the most common cause of this type of top of foot pain, either high heels or shoe with a narrow toe.  They can also develop secondary to a toe injury, a neural or vascular problem or arthritis

Symptoms: Pain and stiffness in the toes.  Abnormal toe positions.

Associated Problems: Corns and calluses often develop on the toes secondary to Hammer, Claw and Mallet toe

Treatment Options: Good fitting footwear toe stretchers e.g. the Yoga Toe, exercises, injections and surgery

Find out more about how these three conditions present, how to tell the difference between them and how to treat them in the Hammer, Claw & Mallet Toe section.

Another common cause of pain on top of foot, especially around the big toe

Gout is a common cause of pain and swelling in the big toe

What Is It: A type of inflammatory arthritis due to high levels of uric acid which cause crystals to form in joints, most commonly the big toe

Causes: Certain medical conditions such as diabetes make you more prone to developing gout, diet (food and drink rich in purines), obesity and genetics

Symptoms: Sudden onset of intense pain, swelling, redness, heat and tenderness, commonly starting at night time.  Symptoms usually settle within a couple of weeks

Treatment Options: Medication, ice, steroids

Find out more including some great ideas on how to prevent gout attacks in the foot gout section.

What Is It: Occurs when a nerve supplying the top of the foot gets pinched or squashed either in the foot itself, further up the leg or in the lower back

Causes: Swelling from an injury to the foot, tight footwear, or dropping something heavy onto the top of the foot

Symptoms: Shooting or burning pain on top of foot sometimes accompanied by pins and needles and/or numbness

Treatment Options: Good fitting footwear, RICE – rest, ice, compression and elevationFind out more about how nerve problems cause pain on top of foot and how to treat them in the nerve pain section.

Athlete’s foot can occur anywhere on the foot and affects approximately 15% of the population globally at some point in their lives.

Athletes foot is a fungal infection on the skin

What Is It: A fungal infection of the skin aka tinea pedis

Causes: Poor foot hygiene. Anything that increases the moisture around the foot e.g. wearing tight shoes, damp socks, warm humid conditions.  Athlete’s foot is contagious and can be passed from person to person or via contaminated surfaces e.g. towels, floors and showers

Symptoms: Foot pain on top, side and bottom. Scaly and flaking skin which is often itchy.  If left untreated, can develop swelling and blisters

Treatment Options: Good hygiene measures, going barefoot, anti-fungal medication, tea-tree oil.  If left untreated the condition can get so bad that amputation is required

8)  Ganglion Cyst

What Is It: Small area of swelling that is filled with jelly-like fluid, usually around the joints of tendons in the foot.  They are generally harmless

Foot ganglions can appear anywhere on the foot

Causes: Can be related to aging or may develop after an injury when fluid escapes from the joint capsule and pools in the nearby soft tissues forming a ganglion cyst.  Often there is no obvious cause

Symptoms:  Small ball of swelling ranging from the size of a pea to a golf ball.  Often pain-free unless it is pressing on a nearby structure e.g. a nerve

Treatment Options: Many disappear over time without any treatment (can take years).  The fluid can be removed with a needle, known as aspiration or the ganglion can be surgically removed but in both cases they recur in 1-in-5 people

9)  Tarsal Coalition

The abnormal joining of tarsal bones known as Tarsal Coalition can cause foot pain

What Is It: Tarsal Coalition is where two or more of the tarsal bones in the foot are joined together with a bridge of bone.  Affects approximately 1% of the population

Causes: This is a congenital problem (i.e. present since birth) and often displays a genetic link

Symptoms: Usually affects children aged 10-15 years old causing foot pain, stiffness and instability

Associated Problems: Can cause recurrent foot and ankle sprains and abnormal foot biomechanics e.g. flat feet

Treatment Options: Orthotics, immobilisation in a cast, surgery

10)  Tibialis Anterior Tendonitis

What Is It: Inflammation and degeneration of the Tibialis Anterior Tendon at the front of the ankle

Inflammation in the Tibialis Anterior tendon causes pain on top of the foot

Causes: Overuse or excessive stress through the tendon e.g. running, kicking and snowboarding particularly going downhill or on uneven surfaces.  Muscle weakness and tightness, poor foot biomechanics, inappropriate exercise technique

Symptoms: Pain on top of foot and front of the ankle.  Worse after activity or prolonged rest.  Symptoms usually come on gradually

Associated Problems: Actions such as kneeling or kicking a ball are often painful

Treatment Options: Rest, ice, exercises, medication, graded return to activity, orthotics

What Next?

These are the ten most common causes of pain on top of foot.  And new incidence of pain should always be assessed by your doctor to ensure an accurate diagnosis. 

To find out more about these common causes of pain on top of foot, choose the appropriate link above.  Or, if you want some help working out what is causing your pain, visit the foot pain diagnosis section.

Go to Diagnosis Overview or Foot Pain Guide

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