Pain on the top of the foot really is a very common problem. Patients will come in very often and complain of a specific pain on the top of their foot. It may be in terms of burning, or a tingling, type sensation that they’re feeling, or a stabbing sensation, especially when they’re moving their ankle joint, trying to extend their toes. The other issue that the patient may have is as they’re walking they’re feeling pain, or when they’re doing activities they’re feeling pain on the top of the foot. That’s associated with swelling. These things tend to be 1 of 3 things, and understanding the anatomy on the top of the foot is very important to being able to to determine which one it is, and then also just kind of understanding what it might be.
Tendonitis, there’s a number of different tendons on the top of the foot, and certainly this can be an issue. Neuritis, there are small cutaneous nerves on the top of the foot, and especially with shoe gear, which is laced too tight, or if you have a high arched foot, you can get neuritis at the top of the foot, that can affect the whole top of the foot, and go down to the toes. Finally, stress fractures, the bones at the top of the foot tend to become the area where they’re symptomatic in stress fractures, and you’ll notice a pinpoint area pain, and some swelling. What we’re going to do is look at the anatomy, then look at what are some of the things that we can do based on that anatomy to help alleviate this problem. If simple modalities don’t work, then really, what you need to do is see a physician so that diagnostic testing can be performed to help evaluate exactly what’s going on. These tests sometimes consist of ultrasound, x-ray, or MRI, would be the most common things that you would initially employ to help differentiate the different problems that you may be suffering from.
In looking at the detailed anatomy on the top of the foot, there are several things that we notice, that are quite prominent, that can help explain possible causes to pain on the top of your foot. We have all of these yellow structures, and these yellow structures represent small cutaneous nerves right under the skin. That’s followed by these white, kind of clear-ish structures, and these are tendons, specifically the extensor tendons that come down from up in the leg, up in here, and help to raise the foot up when you’re walking. The final thing that we see, not too clearly, because it’s obscured, are the bones themselves, and the bones themselves are these white structures that are underneath. We have tendons, we have nerves, and we have bones, and so typically it’s going to be 1 of those 3 things that is going to cause pain to the top of your foot.
One of the symptoms if the pain on the top of your foot is related to the nerves, to the cutaneous nerves, is usually what you’re going to feel is you’re going to feel numbness, burning, or tingling, and that numbness and tingling may be isolated right in the middle of the foot, or it may shoot down to the toes. These nerves do provide sensation to the top of the toes. Usually, patients are going to complain about pain and numbness, especially when they lace their shoes too tight, and that’s found, especially, in people who have high arches.
Top of foot pain when you move your foot up and down, when you’re walking, and you feel the pain in through this area, a lot of times that is going to be tendonitis of these extensor tendons. That’s going to generally be characterized by a steep stabbing pain. You’re generally not going to notice any swelling with that, it’s just going to hurt whenever you try to move the ankle, move the foot. Especially if you try to move that foot down, like that, and point your toes. You’re going to definitely feel pain in through here as you’re stretching out those tendons.
The final thing is pain on the top of your foot as a result of a problem with the bones, specifically a stress fracture. Stress fractures are going to typically manifest themselves as pain, especially as you go off the ball of your foot, and you’re walking, you’re going to feel pain in this area. Really 1 of the characteristics of stress fractures is that you’re going to generally see a mild amount of swelling on the top of the foot, and when you press with your thumb or your index finger, right over the shaft of the bone that’s injured, you’re going to have a significant tenderness, and pinpoint pain to 1 small area. It’s generally not going to be diffused throughout the top of the foot.
Really understanding the anatomy of the top of the foot gives us a much better idea as to what may be going on. We know that most of the pain on the top of the foot typically going to be 3 things. It’s either going to be a nerve issue, a tendon issue, or a bone issue. It can be difficult to discern which 1 it is just based on what the symptoms are. A lot of times we need diagnostic testing, such as an x-ray, or an MRI, or an ultrasound. Some of the things that you might want to try on your own at home before you come into the office is obviously a little bit of icing, icing helps with neuritis issues, it also helps with the tendonitis issue, and rest. If you do these things for a few days, hopefully you’re going to feel better, maybe do a little stretching. If you’re athletic, and into doing activities, then taking a rest from those type of things for a while also may be beneficial. If you find that after several days of doing these simple things, you’re not getting better, and certainly you want to see someone who can then do some diagnostic testing to help determine which one of these things might be going on, on the top of your foot, so then the appropriate treatment can be initiated.