Pain on the top of the foot

There are numerous types of conditions that can cause pain on the top of the foot. This article outlines the most common conditions including their symptoms, causes and treatment.

What conditions cause pain on the top of the foot?

Tibialis Anterior Tendonitis

The Anterior Tibialis muscles run down the front of the shin and attaches to the top of the foot. It can become irritated if it is overloaded from activities such as sudden walking or running increases. Other causes include flat feet and biomechanical issues with your gait.

Symptoms include pain at the start of an activity that improves as it warms up but is often worse afterwards. Stiffness is often present on the top of the foot first thing in the morning.

Strength training is the best form of rehabilitation for this condition, and your physical therapist should create a graded rehabilitation programme.

Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is a condition that affects the top of the foot close to the ankle joint. The Sinus Tarsi is an anatomical tunnel through which nerves and blood vessels pass; if this tunnel becomes irritated or overloaded, inflammation and pain develop, resulting in Sinus Tarsi Syndrome.

Symptoms of Sinus Tarsi include pain, swelling and tingling on the top of the foot and ankle that are aggravated by walking on uneven surfaces, poor footwear or running on a camber. Sinus Tarsi Syndrome can be caused by flat feet, poorly supported footwear and running.

Treatment for Sinus Tarsi Syndrome includes taping, insoles, strengthening exercises, and stability shoes and in case that doesn’t improve, an ultrasound-guided steroid injection can be highly effective.

Related Article: Best Exercises for Sinus Tarsi Syndrome

Stress fracture

5th metatarsal stress fractures are the most common type of metatarsal stress fracture. The 5th metatarsal is located outside the foot; if it becomes overloaded from running, it can develop a hairline fracture. An Avulsion fracture of the 5th metatarsals is where a tendon or ligament pulls off a fragment of bone, while a crush fracture can occur if a heavy object falls on the foot.

The symptoms of a 5th metatarsal fracture include pain when weight bearing with swelling of the foot and bruising. Pain is exacerbated with walking and running and should improve with rest.

In most cases, a 5th Metatarsal Fracture can be detected on an x-ray, but an MRI is sometimes required.

Treatment for a 5th Metatarsal stress fracture usually involves 4-6 weeks in a boot followed by 4-6 weeks of Physical Therapy.

Related Article: Best Boot for 5th Metatarsal Fracture

Midfoot Arthritis

Most bones in the body are surrounded by hard cartilage, and the function of this is to protect the bone. Ligaments attach bone to bone to form a joint, and 5 bones make up the joints of the Midfoot. Midfoot Arthritis develops when the cartilage on one or more of these bones wears down, exposing the bone underneath, which can cause inflammation and pain.

There are multiple potential causes, such as previous trauma to the area, flat feet, Rheumatoid Arthritis and in some cases, Midfoot arthritis can develop without a specific cause.

Midfoot arthritis causes stiffness and pain on the top of the Midfoot when walking and is particularly stiff in the morning.

Treatment includes supportive footwear, insoles, strengthening exercises and non-impact cardiovascular exercise.

Related Article: Symptoms and Treatment for Midfoot Arthritis

Lisfranc Injury

A lisfranc injury is a less common injury of the top of the foot but is very serious if it is not managed correctly. A Lisfranc injury is a fracture or dislocation of the second metatarsal that can provide pain on the top of the foot with mild swelling and bruising on the underside.

To diagnose a Lisfranc injury, multiple angles of x-ray are required, and in some instances, a CT Scan.

Depending on the severity of the injury, surgery may be required or a prolonged period in a walker boot, followed by Physical Therapy.

Common Peroneal Nerve Dysfunction

The common Peroneal nerve is a cutaneous nerve that supplies pain, touch and sensation to the top of the foot. If the nerve becomes irritated through entrapment and impingement from a disc in the lower back it can result in pain on the top of the foot.

Symptoms of Peroneal Nerve Dysfunction include constant burning and pain on the top of the foot, alongside numbness and pins and needles. Symptoms are often worse with activities such as driving and may be present at night.

Diagnosis may be achieved in a clinical setting with a Physical Therapist following a Physical examination, and they may refer you for an MRI to establish greater clarity on the diagnosis.

Treatment includes mobility, stability and strengthening exercises under a Physical Therapist’s guidance. In stubborn cases, an ultrasound-guided steroid injection may be required to reduce inflammation levels.

Tarsal Coalition

A tarsal coalition is a rare cause of pain at the top of the foot, and it involves the bone coalition of two bones that form at birth and is often hereditary.

The coalition of the two bones can restrict motion in the top of the foot; making is painful to carry out impact activities such as running and jumping. There may be slight swelling or bruising, but it is usually tender to touch over the affected bones.

Treatment for a Tarsal Coalition includes insoles, strengthening exercises and stability shoes.

Related Article: Treatment for Tarsal Coalition

Physiotherapy with James McCormack

This is not medical advice and we recommend a consultation with a medical professional such as James McCormack before trying any of these exercises. James offers Online Physiotherapy Appointments for £45.

What causes pain on top of the foot?