Foot pain in top middle of foot

05/24/2019

While pain in the top of the foot, or midfoot, may seem unusual, it is a very common symptom for a foot and ankle orthopedic 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.

Sharp, burning pain at the top of the foot is a common reason to visit a podiatrist.

Depending on the severity, this pain may make it difficult to stand, walk, or run.

It may be intermittent or chronic.

Even though the feet are designed to bear our weight and handle a lot of stress every day, they are still susceptible to pain and injury.

Symptoms Associated with Top of Foot Pain

You may experience:

• Redness, swelling, warmth, or tenderness at the site of the pain
• Difficulty standing and walking
• Pain that decreases when resting and increases when standing or walking

Common Causes of Top of Foot Pain

#1 Stress Fractures

A stress fracture is a small crack or a severe bruising in one of the bones of your foot.

Many stress fractures occur in the metatarsal bones, which are the 5 tubular bones that run down the middle of your foot.

The second and third metatarsals are the most prone to stress fractures. This is because they are the thinnest and longest of the 5 bones, and they bear the greatest impact when you walk or run.

There are also other areas of the foot which can be impacted by stress fractures.

These include the heel, the fibula (the outer bone of the lower leg and ankle), the talus (the small bone in the ankle joint) and the navicular (the bone on top of the middle of the foot).

Stress fractures are very common in runners and other types of athletes who expose their feet to intense exercise, and therefore prolonged pressure.

People who are obese or who have jobs that require repetitious physical labor are also at risk for stress fractures.

When you have a stress fracture in your foot, there is usually swelling and the area is painful to the touch.

A few weeks of rest (avoiding pressure on the foot) and proper shoe gear will resolve stress fractures most of the time.

#2 Arthritis

Pain on top of the foot during normal everyday activities may indicate arthritis.

Typically, the pain from arthritis occurs in the middle of the foot, and is known as Midfoot Arthritis.

Midfoot Arthrtis has two predominant causes.

The first is a sprain or serious injury to the middle of the foot, and the second is the degeneration of cartilage due to extreme amounts of wear and tear.

Arthritis in the foot most often affects older people who have been walking and running for many years.

Treatments include anti-inflammatory medications, proper shoes, and orthotic shoe inserts to support the foot.

Surgery is sometimes required because arthritis involves changes to bone structure that can only be corrected with an operation.

#3 Tarsal Coalition

Tarsal coalition affects children and young adults, and is the result of an abnormal fusion (coalition) of two or more of the middle bones of the foot (the tarsals).

It is a congenital condition, meaning that it is present at birth and occurs during fetal development.

One in about every 100 people develops the condition.

Tarsal Coalition usually begins between the ages of 10 and 14 with pain, fatigue, muscle cramps and spasms, and decreased range of motion in the feet.

These symptoms emerge suddenly and do not stop.

If untreated, tarsal fusion can cause significant arthritis which may limit the child’s activity.

A podiatrist may recommend anti-inflammatory treatments, orthoses, or surgery to restore normal function.

#4 Extensor Tendinitis

Extensor tendinitis involves inflammation of the tendons near the middle top of the foot.

The calf muscle may be tight, placing stress on the tendons at the top of the foot that pull the foot upward.

Another very common cause of the condition is the foot rubbing against a shoe.

This has the biggest impact on people who spend long periods of time on their feet, who often walk or run on uneven surfaces and who tie their shoes too tightly.

Wearing shoes with a 1-inch heel may help relieve the strain.

Stretching the calf muscle is another useful treatment, as are oral anti-inflammatory medications.

When these measures don’t work, custom orthotics can take the stress off the tendons by correcting the alignment of the foot.

#5 Flat Feet

Flat feet can cause pinching in the small ligaments of the foot, leading to pain on top of the foot.

If you suffer from flat feet, make sure you wear shoes with extra cushioning and soft platforms.

Getting support for your arches is key. Stay away from high heels, and consult with your podiatrist about having a pair of custom orthotics made.

#6 Gout

Pain on top of your foot around the area of the big toe may be a sign of gout.

Gout is a form of inflammatory arthritis, and is caused by high amounts of uric acid in the blood.

As the acid crystallizes, deposits form in the joints and tendons, causing severe pain in the big toe as well as swollen joints.

Prescription medication to block uric acid production is the most common treatment for gout.

Resting your foot and using ice to reduce swelling is also recommended.

#7 Diabetes

Diabetic peripheral neuropathy can cause acute pain in your feet.

If you suffer from diabetes, it’s imperative that you check your feet daily for any signs of irritation or infection.

Always wear good-fitting shoes, and make sure that they aren’t too tight. Soaking your feet in warm (not hot) water can also help.

#8 Tight Shoes

Wearing ill-fitting, tight shoes is a leading cause of pain on top of the foot.

Always make sure that your shoes are wide enough for your toes to move freely.

Avoid wearing high heels that can push your feet forward and crush your toes.

* Please note that only your podiatrist can correctly interpret the type and location of the pain to identify and treat its cause.

When to See a Doctor

Consider making an appointment as soon as you feel pain on the top of your foot.

Pain in this area is not normal, and may indicate a much more serious condition which should be treated as soon as possible.

Left untreated, the underlying cause of the pain might require more extensive treatment and treatment may be less likely to alleviate the problem.

What Questions Should I Ask the Podiatrist?

1. What are the chances the pain will continue?
2. If the pain doesn’t stop, how long should I wait before coming back?
3. What will happen if I delay or refuse treatment?
4. Can I address the underlying cause of this problem?
5. Should I make any changes to my diet and lifestyle?

What To Do Now

If you are experiencing pain on the top of your feet and need to see a podiatrist, we can help. Our podiatrists specialize in treating all conditions that can cause pain on the top of your feet.

To schedule your appointment give us a call today at 301-937-5666 or just fill out the form on the top right of this page.