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What are the Most Common Causes of Pain on the Top of the Foot?

By Deborah Walker
Updated May 17, 2024
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Pain on the top of the foot may be caused by bone fractures, tendinitis, inflamed ligaments, arthritis, bone spurs, or tarsal coalition. The location of the pain and its onset help doctors make an accurate diagnosis and recommend appropriate treatment. Depending on the cause of the pain, the treatment may be stretching, anti-inflammatory medication, casting, surgery, or orthotics.

Stress fractures may cause pain on the top of the foot. Athletes, particularly runners, tend to get stress fractures in line with the second, third, or fourth toes. The break may occur even when there has been no injury to the foot immediately preceding the pain. The pain tends to be sharp, may come on suddenly, and the area may be sore and swollen. Treatment usually consists of nonsteroidal anti-inflammatories, ice, and rest.

If the pain is on the top inside of the foot, the navicular bone may have a stress fracture. This type of fracture can be difficult to diagnose because it does not always show up on x-rays. Many times a CT scan or MRI is necessary to make the diagnosis. If the pain is caused by a stress fracture, the doctor may recommend anti-inflammatory medications, shoe orthotics, limited activity, and/or a walking cast. Surgery is rarely necessary.

Tendinitis is another very common cause of pain on the top of the foot. Very tight calf muscles can cause extensor tendinitis, or inflammation of the extensor tendon that connects the ankle to the foot bones. Extensor tendinitis pain is localized to the top middle and outside edge of the foot. Orthopedists may suggest wearing a shoe with a 1 inch (2.5 centimeter) heel, stretching the calf muscle, anti-inflammatory medication, or orthotics.

Inflamed ligaments may cause pain in the area below the ankle towards the outside of the foot. Three small ligaments run through this area. These ligaments may become inflamed if a person has flat feet or if the two bones that run next to the ligaments press against each other. Stretching the calf muscles, anti-inflammatory medications or orthotics may help. The doctor might recommend cortisone injections or, rarely, surgery.

Degenerative arthritis in the big toe joint is another reason one may have pain on the top of the foot. If the joint is jammed, a bone spur may result. Wearing shoes may aggravate the condition. Anti-inflammatories and orthotics are the most common treatments. Sometimes surgery is prescribed for severe cases of arthritis about the big toe.

Children and young adults may complain of pain in the foot located more towards the outside edge. Tarsal coalition, or a fusion of two or more of the foot's bones, may be responsible for the pain. It tends to worsen with any activity. If not treated early, tarsal coalition may result in severe arthritis. Orthotics are generally used to treat tarsal coalition.

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