Pain on Top of the Foot | Galleria Podiatry

pain on top of foot diagram

A. Ankle Sprain

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. It occurs when the foot is twisted or turned more than the ligaments can withstand, often during physical activities but also in everyday movements like stepping on an uneven surface.

Pain Caused by an Ankle Sprain

  • The nature of pain is immediate and can range from mild to severe, depending on the extent of the injury. Mild sprains may cause slight pain and discomfort, while severe sprains can result in intense pain that makes it difficult or impossible to bear weight on the affected foot.
  • Symptoms – along with pain, common symptoms of an ankle sprain include swelling, bruising, and a restricted range of motion. The area around the ankle may feel tender to the touch, and the swelling can significantly alter the appearance of the ankle, making it look puffy or distorted.
  • Pain Progression – the pain may initially be sharp, especially upon movement or applying pressure to the ankle. As the injury begins to heal, the acute pain usually subsides but may be replaced by a dull ache or discomfort that can linger, especially with movement or after prolonged periods of inactivity.

Treatment typically involves rest, ice, compression, and elevation (RICE) to reduce swelling and pain. More severe sprains might require immobilisation with a brace or cast to allow the ligaments to heal properly. Rehabilitation exercises and physical therapy are often recommended to restore strength and flexibility to the ankle. In cases of extremely severe sprains, surgical intervention might be considered to repair torn ligaments.

B. Posterior Ttibial Tendonitis

Posterior tibial tendonitis is an inflammation or injury of the posterior tibial tendon, which runs along the inside of the ankle and foot and plays a crucial role in supporting the arch of the foot and helping in foot movement. The condition is often seen in runners, hikers, and individuals who engage in activities that involve repetitive impact on the foot.

Pain Caused by Posterior Tibial Tendonitis

  • Location and nature of pain – the pain primarily occurs along the inside of the ankle and into the arch of the foot. It can be a sharp pain or a dull ache, and is usually exacerbated by activities that put strain on the tendon, such as walking, running, or climbing.
  • In addition to pain, symptoms may include swelling along the course of the tendon, warmth, and redness over the area. Over time, as the tendon’s ability to support the arch decreases, there may be a flattening of the foot and an inward rolling of the ankle.
  • The pain generally worsens with continued activity, particularly activities that strain the inner aspect of the foot and ankle. Early in the condition, the pain might only be noticeable during or after intense physical activity, but as the condition progresses, it can become painful during normal daily activities.

Treatment involves resting the foot, using ice to reduce inflammation, and taking anti-inflammatory medications to manage pain. Orthotics or braces may be used to support the foot and reduce strain on the tendon. Physical therapy focusing on strengthening and stretching exercises is also commonly recommended. In some cases, surgery may be required to repair the damaged tendon.

C. Extensor Tendonitis

Extensor tendonitis is an inflammation of the extensor tendons, which are located on the top of the foot and are responsible for pulling the foot upwards. This condition is often caused by overuse, particularly in activities that require repetitive foot movements or are high-impact, such as running or hiking. It can also result from wearing tight-fitting shoes that put excessive pressure on the tendons on the top of the foot.

Pain Experienced from Extensor Tendonitis

  • Location and nature of pain – the pain is typically felt on the top of the foot and can extend into the toes. It may be sharp or dull and is often exacerbated by activity, especially those that involve lifting the foot or toes upward.
  • Symptoms – in addition to pain, other symptoms include swelling and redness along the top of the foot. The area over the inflamed tendons may be tender to the touch, and moving the toes or foot upwards against resistance can increase discomfort.
  • Progression – the pain generally becomes more pronounced during activities that stress the tendons and may subside somewhat with rest. If the activity that exacerbates the condition continues without proper treatment or modifications, the pain can become persistent and affect daily activities.

Treatment for extensor tendonitis typically includes rest and avoiding activities that aggravate the condition. Ice applications and anti-inflammatory medications can help reduce inflammation and manage pain. Footwear modifications, such as using shoes with a softer upper and more room, can also alleviate pressure on the tendons. Stretching and strengthening exercises for the foot and ankle muscles, guided by a physical therapist, are important to prevent future recurrences of the condition. In some cases, additional physical therapy, custom orthotics, or even corticosteroid injections might be considered.

D. Bunion

A bunion, medically known as hallux valgus, is a bony bump that forms on the joint at the base of the big toe. This deformity occurs when the big toe starts to angle inward towards the second toe, forcing the joint to stick outwards. Bunions develop gradually, and their exact cause can include genetic predispositions, biomechanical imbalances, or inappropriate footwear that constricts the toes.

Pain Caused by a Bunion

  • Location and nature of pain – the pain is primarily located at the joint of the big toe and can vary from mild to severe. The protruding joint can become inflamed and sore, often exacerbated by pressure from shoes, particularly those that are tight or narrow.
  • Symptoms – alongside the pain, bunions can cause significant swelling, redness, and a burning sensation at the joint. The skin over the bunion might also become calloused or irritated, and movement of the toe may be limited or painful.
  • Progression – as the bunion grows, it can lead to increased pain, especially when wearing shoes or walking. Over time, the continued misalignment of the toe joint can lead to chronic pain and might affect the foot’s ability to function normally. The angle of the big toe can also lead to additional complications like hammertoes, bursitis, or arthritis in the joint.

Treatment typically starts conservatively with changes in footwear to accommodate the bunion and alleviate pressure on the toe joint. Pads, splints, or custom orthotics may be used to help position the foot correctly and relieve stress on the toe. Over-the-counter pain relievers and anti-inflammatory medications can manage pain and swelling. For severe cases where conservative treatments do not provide relief, surgical options are available to realign the toe and remove the bunion. Surgery aims to correct the deformity and reduce pain but involves recovery time and, as with all surgeries, carries risks of complications.

E. Sinus Tarsi Syndrome

Sinus tarsi syndrome is a condition that affects the sinus tarsi, a small canal located between the talus and calcaneus bones in the ankle. This area is filled with ligaments and fatty tissues that can become inflamed, often due to repetitive twisting injuries or overuse, particularly in athletes or individuals with abnormal foot biomechanics such as flat feet or high arches.

Pain Caused by Sinus Tarsi Syndrome

  • Location and nature of pain – the pain is typically localized to the outer side of the ankle, just in front of the ankle bone. It can be a dull ache or a sharp, stabbing pain, especially when the foot is actively moved or during walking.
  • Symptoms – common symptoms include tenderness and swelling in the sinus tarsi area, which may be noticeable when pressing on this part of the ankle. People with this syndrome often experience instability in the ankle, feeling as if the ankle might ‘give way’ while walking on uneven surfaces or during activities that involve pivoting.
  • Progression – the pain and discomfort may worsen with continued activity and improve with rest. Without treatment, the condition can lead to chronic pain and persistent feelings of instability in the ankle.

Treatment for sinus tarsi syndrome typically includes rest, ice, and anti-inflammatory medications to reduce inflammation and pain. Physical therapy may be recommended to strengthen the ankle, improve mobility, and address any underlying biomechanical issues. Custom orthotics or supportive footwear might also be beneficial in providing stability and reducing strain on the sinus tarsi.

E. Stress Fracture

woman experiencing pain on top of the foot caused by stress fracture
Stress Fracture (top of foot pain)

A stress fracture in the foot is a small crack in a bone or severe bruising within a bone, most commonly occurring due to repetitive force, overuse, or chronic strain. It often affects athletes who engage in running and jumping sports but can also occur in individuals who suddenly increase their physical activity levels without adequate conditioning.

Pain Caused by a Stress Fracture in the Foot

  • Location and nature of pain – the pain is usually localized to the area of the fracture and can vary depending on which bone is affected. Common sites for stress fractures in the foot include the metatarsal bones (near the middle of the foot), the navicular (top of the midfoot), or the calcaneus (heel bone).
  • Symptoms – the pain typically develops gradually and increases with weight-bearing activity. It might diminish with rest but returns when activity resumes. There may be swelling, tenderness, and bruising in the affected area. The pain often starts as manageable but becomes progressively worse, potentially to the point where even walking is painful.
  • Progression – if a stress fracture is not properly treated, the pain can become constant and more severe, potentially leading to a complete break of the bone.

Treatment for a stress fracture generally involves rest and avoiding activities that put stress on the foot until the bone has healed, which can take several weeks to months. Ice, elevation, and over-the-counter pain relievers may help alleviate symptoms. Protective footwear or a walking boot may also be necessary to offload pressure from the foot. In some cases, particularly if the stress fracture is in a bone that has a poor blood supply, more aggressive treatment such as surgery might be required. Rehabilitation exercises may be recommended to strengthen the foot and improve flexibility as the fracture heals.

G. Hammer Toe

A hammer toe is a deformity of the second, third, or fourth toes where the toe is bent at the middle joint, causing it to resemble a hammer. This condition most commonly arises from wearing ill-fitting shoes that are too tight, short, or pointy at the toes, leading to an abnormal bending of the toe. Hammer toe can also be caused by an imbalance in the muscles, tendons, or ligaments that normally keep the toe straight.

Pain Caused by Hammer Toe

  • Location and nature of pain – the pain is primarily located at the bent joint of the affected toe. Over time, the toe may become rigid in its bent position, leading to persistent discomfort.
  • Symptoms – hammer toe causes pain and irritation when wearing shoes, as the bent toe rubs against the shoe, leading to inflammation or sores. Corns or calluses often develop on the top of the toe or on the sole of the foot due to this constant friction. Additionally, the misalignment of the toe can cause pain and discomfort in the ball of the foot, especially when walking.
  • Progression – initially, the toe may remain flexible, and pain can be mild and intermittent, but as the condition progresses, the toe can become fixed in a bent position. When this happens, the pain can become more constant and severe, potentially affecting walking and other activities.

Treatment for hammer toe typically includes changing to more appropriately sized and shaped footwear to relieve pressure on the toe, using pads or inserts to reduce friction, and doing toe exercises to stretch and strengthen the muscles. In cases where the toe has become rigid, or the pain is severe, surgery might be necessary to correct the deformity and relieve the pain.

H. Shin Splints

Although shin splints do not typically cause pain on the top of the foot, we are adding them to this list because they can cause pain in the lower leg. Shin splints, technically known as medial tibial stress syndrome, is a condition characterised by pain along the inner edge of the shinbone (tibia). It commonly affects runners, dancers, military recruits, and other people engaged in high-impact activities. The condition arises from excessive stress on the shinbone and the connective tissues that attach muscles to the bone.

Pain Caused by Shin Splints

  • Location of pain – Shin splints predominantly affect the front portion of the lower leg along the shinbone (tibia), specifically targeting the inner edge of the bone. The pain of shin splints is less common at the back of the leg. If pain is experienced at the back of the lower leg, it is more likely related to other conditions, such as calf muscle strains, Achilles tendonitis, or other issues involving the muscles and tendons at the back of the leg.
  • Nature of pain – the pain usually starts as a dull ache, which can become sharp and intense during and after exercise. The area may be tender to the touch and sometimes exhibits mild swelling.
  • Symptoms during activity – the pain often begins at the start of a physical activity and initially subsides during the course of the exercise, only to return worse after the activity concludes.
  • Progression – If the activity that causes the shin splints continues without proper treatment or adjustment, the pain can become continuous and might even lead to stress fractures.

To treat shin splints, rest, ice, and pain management can be used initially. Applying ice for 20-30 minutes several times a day and taking over-the-counter pain relievers can help reduce inflammation and pain. Once the acute pain subsides, stretching and strengthening exercises for the lower legs can prevent reoccurrence. Proper footwear and gradually increasing the intensity of physical activities can help in long-term management. Consult a sports podiatrist if symptoms persist.

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