One of the most common cause pain on top of the foot is extensor tendonitis. Here we explain the causes of gradual onset and sudden onset, acute injures.
When should I see a doctor?
If any of the following apply then seek professional medical advice:
- If you have severe pain or swelling, and are unable to complete normal daily tasks three days after injury.
- Or if your have any change in sensation in your foot. For example, numbness, or pins and needles then also seek medical advice.
- If you have rested and applied the PRICE principles for two weeks and still have pain or weakness.
Extensor tendinitis is inflammation of the extensor tendons which run along the top of the foot. It is an overuse injury with symptoms including:
- Pain over the top of your foot.
- Symptoms will have occurred gradually over time rather than from a single traumatic incident.
- You might complain of an aching pain on top of the foot, made worse with running and improves with rest.
- There may also be swelling or redness over the top of your foot.
Read more on Extensor tendonitis.
Lisfranc injury is a dislocation or fracture in the midfoot area, and if missed can have serious long-term implications. It occurs in the middle of the foot at the joint where the short metatarsal bones meet the long bones in the foot. Symptoms include pain in the midfoot area with difficulty putting any weight on the foot, and in particular, difficulty going up onto the toes. There may be some bone deformity visible but not always. Swelling is likely on the top of the foot and there will be tenderness over the joint area.
If you suspect a Lisfranc injury or even a midtarsal joint sprain, then seek medical advice immediately. Delaying treatment of Lisfranc injury can cause long-term or permanent damage to the foot. A doctor will X-ray the foot in a weight-bearing position. However, this injury is often missed even with an x-ray, so if the therapist suspects Lisfranc injury and it is not obvious through X-ray then MRI or bone scan is required to confirm the diagnosis.
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Midtarsal Joint Sprain
A midtarsal joint sprain is an injury or tear to the any of the ligaments holding the midtarsal bones together. The symptoms and severity of a midtarsal joint sprain will depend on which ligaments have been sprained. Pain will be felt on the outside middle of the foot and there may be swelling on the outside and/or top of the foot. Certain movements will trigger pain but the precise location of the pain will depend on which ligaments are injured.
The two most commonly injured ligaments are the calcaneocuboid ligament on the top of the foot (connects the Calcaneus and the Cuboid), and the Bifurcate ligament (a Y shaped ligament). Treatment will mean immobilization in a cast for up to six weeks and/or surgery to pin the bones together. This injury is rare but can occur in gymnasts, footballers, and jumpers. With any midfoot sprain or fracture, it is important to consider a Lisfrancs injury which can have serious long-term implications if missed.
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Navicular stress fracture
A navicular stress fracture is a hairline fracture of one of the tarsal bones called the Navicular. It is one of the most common stress fractures affecting athletes, especially those in explosive sprinting and jumping type sports. Symptoms include a poorly localized ache in the midfoot area which gets worse with exercise. Pain may radiate along the inside arch of the foot and pressing into the top of the foot over the Navicular bone itself (called the N spot) and will be painful and tender.
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Morton’s neuroma or Morton’s syndrome occurs when a nerve becomes trapped between the third and fourth toes causing pain, numbness, and a tingling sensation over the top of the forefoot. Pain is made worse by weight-bearing, particularly up onto the toes and can also be reproduced by squeezing the forefoot to further compress the nerve. Morton’s neuroma can be caused by wearing ill-fitting shoes which press against the nerve, as well as activities which involve spinning on the ball of the foot, such as golfers and tennis players.
Treatment involves reducing pain and inflammation through rest, applying cold therapy, and inserting padding under the forefoot in order to spread the metatarsal bones, therefore decreasing the compression of the nerve. A doctor may prescribe anti-inflammatory medication and any biomechanical problems of the foot, such as overpronation should be corrected.
Read more on Mortons neuroma.