What Causes Pain on the Top of Your Foot?

There can be many reasons why you might be experiencing pain atop your foot, and a tight fitting shoe wouldn’t necessarily be the only one, although pressure on the dorsum of one or both of your feet can certainly cause pain, especially while you’re walking or running.

When you consider the anatomy of your foot, it’s little wonder that occasionally experiencing discomfort on top of it isn’t much more common. Your foot has more than its share of muscles, tendons, bones, and joints, many of which lie quite near the surface. Given the fact that so much weight and pressure is constantly being placed on each foot, it’s understandable that a painful disorder will make its presence known from time to time; and when your feet hurt, you hurt.

The Foot’s Anatomy – Bones

If you look at a side view of the bones of your foot, the first thing you may notice is that the majority of those bones lie closer to the foot’s dorsum than to the bottom. The only bone that is strictly a bottom-of-the-foot bone is the calcaneus or heel bone. The phalanges, which are the bones between the joints of the toes, are close to both the top and bottom of one’s foot but are actually a bit closer to the top portion, largely because the bottom is heavily padded, while the top is not.

The five metatarsal bones, connecting the toes to the three cuneiform bones and the cuboid bone, lie very close to the dorsal surface of one’s foot. An injury to any one of them could easily be felt at the top of the foot (dorsum pedis), especially if pressure is being applied. One of the more common injures sustained by a metatarsal bone is a stress fracture, which can be quite painful. The same is true of the cuneiform and cuboid bones, which serve to connect the foot to the ankle joint. The talus bone is considered to be a part of the ankle joint, as it supports the two lower leg bones, but if it is injured, pain could be anticipated since the talus is located on the dorsum pedis at the ankle. The navicular bone is a foot bone, but it is also a part of the ankle joint. The navicular bone is also located at the dorsum of the foot, and like a metatarsal bone, it is a bone in which a painful stress fracture can sometimes occur. A stress fracture of the navicular bone is most likely to occur among athletes and other highly active individuals.

All in all, there are 26 bones in the foot plus the talus, which, if injured, could cause pain to be felt on the dorsum pedis.

The Foot’s Anatomy – Muscles, Tendons, and Ligaments

There are nearly as many muscles in each foot as there are bones, twenty to be exact. These include the anterior tibial which enables the foot to move forward, the posterior tibial which supports the arch, and the peroneal tibial that controls movement on the outside of the ankle. The extensor muscles help the ankle to raise the toes when you take a step forward, while the flexor muscles serve to stabilize the toes when they are on the ground. Besides these main foot muscles, there are a number of smaller muscles that help you to lift and curl your toes. It is the extensors, many of which run from near the toes to above the ankles that are most likely to cause discomfort on the dorsal surface if injured rather than on the bottom or at the sides.

The same can be said for the tendons, which connect muscle to bone. It is the extensor tendons that are capable of causing pain anywhere from the lower leg to the tips of the toes. Ligaments help to hold both bones and muscles in place. An injured foot ligament will most likely cause discomfort on the bottom of the affected foot, although a damaged ankle ligament could cause pain in the top or side of the affected foot, as well as in the ankle itself.

Causes of Top-of-the-Foot Pain

Below are the seven most common causes of pain that are likely to be experienced on the dorsum pedis. One of the most common causes of all, severe injury due to trauma, is not included among the seven due to its many causes and symptoms, and has therefore been assigned to the ‘miscellaneous’ category.

• Degenerative Arthritis – Degenerative arthritis often causes the arch of the foot to gradually collapse. While collapsed arches or ‘flat feet’ are generally thought of as causing pain on the bottoms of the feet, when arthritis is the cause, the pain most often tends to be felt atop the feet. Degenerative arthritis can also cause the top of each foot to be painful when it is present in the joint of the big toe. The pain can be especially severe when pressure is being put on the toe while putting on a shoe. If you have degenerative arthritis in the big toe joint, it usually responds much better to treatment than does the arthritis that might be affecting the arch of your foot. Arthritis, in some cases, will cause painful bone spurs to develop.
• Tarsal Coalition – Tarsal coalition is a condition experienced mainly by children and younger adults. The condition is one in which two or more of the bones of the feet have fused together, one of which is typically a metatarsal bone. This fusion will influence the ability of the feet to flex properly, and the pain it can cause is most often felt atop the outside part of the feet. Tarsal coalition is sometimes hereditary. It is usually easily treated if caught early. In some instances, surgery may be necessary.
• Pinched Ligaments – It was noted earlier that ligaments are not normally a source of discomfort on the foot’s top part. There is at least one exception, and that has to do with three small ligaments that are located on the outside of the feet just below the ankle joint. These three ligaments run through a tunnel called the Sinus Tarsi. This tunnel is located between two bones. Flat feet can sometimes cause these bones to move towards one another and pinch the Sinus Tarsi,   consequently pinching and irritating the three small ligaments that lie inside it, which can cause them to become inflamed and painful. Pain is then likely to be experienced on the dorsum pedis near the ankle.
• Ganglion Cyst – Ganglion cysts are more commonly encountered in the wrist area, but do on occasion occur on one of the feet as well; most often atop a foot. A ganglion cyst is a soft, fluid-filled mass that is aptly referred to as a knot. These cysts are benign and are generally harmless. They mainly cause problems because of where they are located. A ganglion cyst atop your foot can make shoes uncomfortable, especially if the compressed cyst is putting pressure against a joint, a nerve, or a tendon. A ganglion cyst is often referred to as a knot since it tends to consist of a mass of clearly defined tissues just beneath the skin. Most people, however, will call it a lump. No one knows the cause of these cysts, as they tend to come and go on their own. They are most commonly treated by aspiration techniques.
• Tendonitis – Tendonitis is a fairly common cause of pain on the dorsal part of foot, but it is more prevalent among athletes due to the wear and tear that is often placed on the tendons. One of the more frequent causes of tendonitis in the feet is when calf muscles have for whatever reason become overly tight. Tying your shoes too tightly, especially your running shoes, is another cause of this type of pain. The tendons involved are almost always the extensors, the long tendons that run just under the top surface of each foot. The pain that tendonitis causes is usually felt nearest the toes and above the ball of every foot, but if left unattended, that pain would often migrate towards the top of the foot’s middle part.
• Hallux Limitus – Hallux limitus is a condition in which the normal motion of the first metatarsophalangeal joint, or big toe joint, has for some reason become limited. The big toe can no longer move freely up and down. Such a condition is in itself not necessarily painful although it could be mildly irritating. What happens however is that supportive tissues, such as nearby tendons, muscles, and ligaments come to the rescue and attempt to take up the slack. This can result in them becoming overworked or overstressed, particularly in the case of the tendons. The result can be irritation, inflammation, and pain atop your foot. An extreme case of hallux limitus (limitus meaning limited) is hallux rigidus, in which the big toe joint has become rigid, and quite possibly fused. Hallux rigidus can be extremely painful and quite often requires corrective surgery.
• Metatarsalgia – Metatarsalgia is actually a collection of symptoms whose cause can best be explained as something that does not allow any foot to function properly. In other words, there is not one single cause. It is the metatarsal joints that are affected however, and it is the metatarsal joints associated with the three middle toes of every foot where pain is most often felt. The pain tends to be localized, although it is sometimes experienced as either shooting pains in the middle toes, or numbness in those toes. Pain can also be more of an aching sensation. Metatarsal pain can be an acute, one-time-only event, it can be recurrent, or in some cases it can become chronic. In the majority of cases, the pain associated with metatarsalgia is located in the ball of each foot, or in the bottom of each foot. This condition is mentioned here because there are instances in which the pain it can cause will be felt in the dorsum pedis.
• Miscellaneous Causes – An obvious cause, but not mentioned up to this point is trauma, including fractures, strains and sprains. When someone steps on and bruises the top portion of your foot, it will hurt. Other causes include improper footwear, ingrown toenails, and hammertoe. Pregnancy can sometimes be a cause, both due to the extra weight being placed on each foot and by hormone imbalances. Some medications can contribute to top-of-the-foot pain, as can aging.

Treatments for Top-of-the-Foot Pain

The choice of treatment for these types of pain naturally depends not only on the symptoms, but also on the cause if known, and on the severity. Except in cases of injury and damage to tissues, treatment tends to mainly consist of some combination of anti-inflammatory medications and cortisone shots, the use of functional orthotics, or surgery. In some instances, all that is required is getting into the habit of stretching the calf muscles to give them some added flexibility. Diagnosis often requires an MRI or a bone scan, since x-rays are not always informative except in cases of larger fractures, bone spurs, or the disfiguration of a joint.