Pain on top of foot when standing

While pain in the top of the foot, or midfoot, may seem unusual, it is a very common symptom for a foot and ankle orthopaedic surgeon to see in practice.

Midfoot Injury

The first thing to think about is if a potential injury occurred.  For example, a heavy object falls on a person’s foot.   They are sore and not active for a little while, improve to some extent, but continue to have midfoot pain several weeks later. It can be easy to forget the initial incident as a potential cause for the pain. Automobile accidents are also a common source of injury.

A group of small bones make up the Lisfranc area or midfoot. These bones form the arch from the heel to the ball of the foot. Crush or twisting injuries to the midfoot can result in fractures or ligament damage in the midfoot.  Such fractures and ligament tears are often referred to as Lisfranc injuries.  Walking is often very painful, and there is often tenderness, swelling and bruising.

Another common cause of midfoot pain is a stress fracture.  Most commonly, stress fractures occur during an increase in running or other impact activity.  Runners who are increasing mileage in preparation for a race and high school athletes engaged in pre-season track or cross-country conditioning are two situations where we see midfoot stress fractures.

Fracture of Fifth Metatarsal

If the pain is concentrated towards the outside of the midfoot, the trouble may involve the fifth metatarsal. This bone connects the middle of the foot to the pinky toe and is one of the easiest bones in the body to fracture without realizing it. Some common instances are:

• Jones Fracture: when the bone fractures near the middle outside of the foot
• Avulsion Fracture: when a tendon or ligament pulls a small piece of the bone out of place. Most often, this happens during an ankle sprain.
• Midshaft Fracture: when the bone breaks in the middle, usually from an accident or severe twisting of the foot.

Extensor Tendinitis

The extensor tendons are run alongside the top of the foot and are needed for pulling the entire foot upward so that the toes are pointing towards the sky. If they become torn or inflamed due to overuse or wearing shoes that don’t offer proper arch support, this is diagnosed as extensor tendinitis.  Pain tends to increase with activity, and swelling is also common.

Arthritis or Other Long-Term Conditions

With so many small bones and joints, the foot is a common place for arthritis to occur.  Painful arthritis can occur at the base of the big toe, in the midfoot toward the top of the arch, and in the hindfoot.

Diabetes and Gout can also lead to pain on the midfoot. Pain from gout usually comes on quickly,  It more commonly seen in the big toe than on the top of the foot.  Diabetes can lead to neuropathy, where the small nerves in the foot and ankle don’t work properly.   Symptoms of neuropathy often start in the toes and are characterized by burning and numbness.

Ganglion Cysts

A ganglion cyst appears as a bump underneath the skin. These are typically fairly simple to diagnose, but the pain they cause will be dependent on their location. Is the cyst putting pressure on a nerve, muscle, joint or the shoe? The cyst’s proximity to any of these things will make it more painful.

Treatment

As you can see, pain on top of the foot can be a sign of many different issues. At OrthoNebraska, our first goal is to arrive at an accurate diagnosis based on the medical history, a physical exam and, in many cases, imaging tests like X-ray or MRI.

Treatment will depend on the underlying cause of the pain and how much it impacts your daily life. From most conservative to invasive, treatments considered may include:

• Rest
• Inserts
• Splinting
• Over-the-counter medication such as ibuprofen
• Prescription medication
• Steroid injections
• Physical therapy or exercises
• Minimally-invasive surgery
• Open surgery

Most causes of midfoot pain can be treated without surgery.  Almost always, we initiate conservative, non-surgical treatment, moving from least invasive to more invasive.

Further pinpoint your top of foot pain, or call (402) 609-3000 for an appointment if you are interested in an accurate diagnosis for your foot or ankle problem.

Midfoot Osteoarthritis

You may already know osteoarthritis as the wear and tear type of arthritis that often affects the knees, hips and the big toe joint – but the midfoot is also a very common site of osteoarthritis, and as such, is our #1 cause of pain at the top of the foot.

Midfoot osteoarthritis occurs when the cartilage that covers and protects the surface of the joints in the middle third of the foot thins or wears down, resulting in stiffness, swelling, pain and changes to the joints or bones themselves. All of these factors can make walking difficult and uncomfortable, with the pain primarily being felt at the top of the midfoot. Your symptoms tend to come on gradually over time, though may occur after an accident like dropping something on the foot or a Lisfranc’s injury (below)

To learn more about osteoarthritis in general, click here.

Lisfranc’s Injury

Your Lisfranc joint is where the five long bones of your feet, called your metatarsals, connect with the collection of tarsal bones, towards your ankle.  A Lisfranc injury, or Lisfranc fracture, happens when your metatarsals become misplaced, fractured or sprained, which occurs when your foot is placed under excessive pressure or force.

This injury can occur directly – like from dropping something heavy on your foot or landing hard on your feet after jumping from a height which tears or sprains the ligaments supporting the joint – or indirectly – like tripping and twisting your foot at an angle that then strains your midfoot.

Extensor Tendonitis

Extensor tendonitis is another common culprit of pain at the top of your foot. Your extensor tendons run along the front of your ankle and the top of your feet, connecting to your toes, and helping you point your toes upwards.

Tendonitis is the painful inflammation of the tendons, and it usually happens from overusing the feet and legs or overdoing it during exercise. Uphill running, especially when you go too hard too fast, or suddenly increase your distance or speed, is a common cause of extensor tendonitis as these tendons must work hard to lift the toes up and clear the ground as you run uphill. Wearing shoes that are too tight can also contribute to the problem as these tendons lie near the surface of the foot without much padding or protection.

While it can sometimes affect both feet, you’re more likely to experience foot pain from extensor tendonitis in one foot – and it’s likely to be your leading foot (yes – just like how you can be right-handed, you can be right-footed!). As you continue to push through and use your feet without treating the problem, the pain at the top of your foot is likely to gradually get worse, and you may start to feel more weakness in your feet. 

High Arches in Tight Shoes

If you know you have high arches, or your significant other complains that you ‘stomp around the house like an elephant’ (a telltale sign of a high-arched foot that doesn’t absorb shock well), your shoes may be the problem. 

Having high arches can already cause a number of pains in the feet since the pressure is more heavily focused on the balls and heel of your foot, rather than moving evenly through your foot during each step. Shoes can add to the problem, as the standard shoe width may not be sufficient to comfortably accommodate the height of your arch. The result is pressure, rubbing and irritation on the top of your foot, which also makes you more vulnerable to tendonitis.

If you have high arches, opt for shoes that come in extra wide fittings to give yourself more room, and adjust your lacing techniques – not so tight, and end the laces without using the last two eyelets.

Nerve Problems

Nerve issues feel unique to other causes of pain at the top of the foot since they also cause prickling, tingling, burning and numbing sensations alongside the pain. Since our nerves run from our spine, down our legs and to the feet, the origin of the pain may be much further up the leg than where we feel the symptoms.

Peripheral neuropathy is a nerve problem caused by damaged nerves. It occurs when the malfunctioning nerves send pain signals when there is nothing specific causing the pain. Peripheral neuropathy may be a result of a physical injury, a medical condition like diabetes, an infection, and more. 

Peroneal nerve dysfunction may also cause symptoms on the top of the foot, ranging from mild to severe pain, and may even cause weakness, feeling loss and movement difficulties in the affected foot and leg. Causes of this nerve disorder include knee trauma, a leg fracture, the use of a tight cast, frequently crossing legs, and wearing high-heeled boots.

Stress Fracture

Stress fractures are tiny cracks in your bones that happen when excess stress or pressure is applied to a bone. Unlike a regular fracture that happens instantly, stress fractures come on slowly and gradually, starting as a dull ache or niggle and progressing into a sharp pain as the cracks grow and the stress fracture worsens. Causes include long bouts of exercise without adequate foot support, certain activities like jumping, carrying heavy objects (like a hiking backpack) for long periods, or simply and commonly from running.

What To Do When Your Foot Hurts

If you’ve got pain at the top of your feet, or are getting foot pain when walking, you podiatrist should be your first port of call. Unfortunately, while many people try to wait out their pain in the hopes that it’ll get better on its own, for the majority of people, continuing to walk on aching feet will only make the damage worse. 

How do you relieve pain on the top of your foot?

What does tendonitis on top of foot feel like?