Pain in lower leg and top of foot

The foot has a complex set of tendons, muscles, joints, and bones that enable it to work properly, as well as withstand walking, standing, and other everyday movements.

Many health conditions and injuries, however, can upset the foot’s movement and balance, causing problems and pain.

Pain on top of the foot may seem like an unusual location, particularly if no obvious injury took place there. However, this area can be affected by a variety of conditions and injuries beyond a bone fracture or bruise.

Most foot pain requires, at the very least, rest and extra care to heal. If the pain is due to an underlying health condition, additional medical care may be needed.

Taking note of the pain and symptoms and what came before the problem can help determine the cause. This ensures that correct treatment can be given.

An injury, such as a sprain or bone break, can occur in any part of the foot, including the top.

Problems with the top of the foot can be due to dropping something on the area. There can be other, less obvious causes, however.

Lisfrank or midfoot injury

The middle of the foot is known as the Lisfrank area or midfoot. This area is made up of a group of small bones that help form the foot’s arch.

If one of the midfoot bones is broken or a tendon is inflamed or torn, it may cause pain, swelling, bruising, and redness on the top of the foot.

Midfoot injuries can be caused by accidents, such as a heavy object landing on the foot.

Not all midfoot injuries are due to dropping something or getting the foot stepped on, however. They often occur when someone falls with the foot flexed downward, pulling or straining tendons or fracturing bones.

A hairline or stress fracture can also happen in this area due to overuse, such as from long periods of running or high-impact activity.

Midfoot injuries can be mild to severe, depending on how many tendons or bones are injured. Mild tendon injuries may only require RICE (rest, ice, compression, and elevation) until the tendon has healed.

Severe injuries and bone fractures may require a cast, physical therapy, or surgery.

Fracture of fifth metatarsal

Pain on the outside of the top of the foot is often related to the fifth metatarsal. This is a long bone that connects the little toe to the middle of the foot.

Several types of fractures may occur in the fifth metatarsal:

• Avulsion fracture: This occurs when a tendon or ligament pulls a small piece of the fifth metatarsal out of place. An avulsion fracture often occurs with an “ankle roll” injury and may happen along with an ankle sprain.
• Jones fracture: This type of break often occurs near the top of the fifth metatarsal, close to the outside and middle area of the foot. It can be a small hairline fracture caused by repeated stress and strain on the foot, or it can be a more severe break due to an injury or fall.
• Midshaft fracture: This type of break is often due to an accident or twisting of the foot. It occurs near the middle of the fifth metatarsal.

Fifth metatarsal breaks usually require medical care. Staying off the foot and using RICE is recommended right after the injury. Additional care, such as a cast, boot, or crutches, may also be required.

Surgery can be recommended if:

• the bone is displaced
• there are multiple breaks in the fifth metatarsal or other areas of the foot
• the fracture is not healing as expected

Extensor tendinitis

Tendinitis can occur in many different areas of the feet and legs. The extensor tendons, located in the top of the foot, are needed for flexing or pulling the foot upward.

If they become inflamed due to overuse or wearing shoes without proper support, they may get torn or inflamed. This is known as extensor tendinitis, which can cause significant pain in the top of the foot.

Extensor tendinitis pain usually gets worse with activity, and may also occur alongside swelling of the top of the foot. It may come about after excessive exercise or doing too much exercise, too soon.

The condition can be quite painful, but can often be treated with:

• rest, with or without splinting
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• steroid injections
• physical therapy or exercises

Once the tendon feels better, it is best to ease back into activity slowly to avoid inflaming or injuring the tendon again.

Ganglion cyst

A ganglion cyst forms below the surface of the skin, appearing like a bump or sac filled with fluid.

It often forms on top of the foot and may happen after an injury to the area. The cause of these cysts, however, is not always known.

A ganglion cyst can cause pain if it is pressing against a muscle or joint in the foot. It may also cause tingling or burning if it is located near a nerve. If the cyst is large, it can cause discomfort or pain when it rubs against shoes.

Treatment for a ganglion cyst depends on how much pain it causes:

• Small cysts that are not causing pain can follow a “wait and see” approach.
• Pads or special footwear can be used to avoid rubbing and irritation of the cyst.
• A cyst can be aspirated, where the fluid is removed with a needle. Sometimes, however, the cyst comes back after this treatment.
• Severe, painful cysts can be removed with surgery.

Not all foot pain is related to an injury or overuse. Some health conditions can cause foot pain, especially ones that affect the nerves and joints. Some examples include:

Arthritis

The foot has 30 joints, which makes it a common area for arthritis to occur.

The metatarsophalangeal joint (MCP) is located at the base of each toe and can cause pain on top of the foot if it is affected by arthritis.

Diabetes

Diabetes can cause nerve damage, particularly in the feet. Uncontrolled diabetes can lead to tingling, numbness, and pain in any part of the foot.

Gout

Gout is a disorder that causes a painful buildup of uric acid in the joints. Although gout most commonly affects the big toe, it can affect the top of the foot and other areas of the body.

It usually causes intense pain that comes on quickly, as well as redness, swelling, or tenderness in the affected area.

Because pain on top of the foot can be a sign of many different issues, diagnosis usually involves a doctor taking a person’s medical history, as well as medical tests.

Diagnosis may include a physical exam of the foot, X-rays, MRI, or other imaging scans. Testing for diabetes, gout, and other diseases may also be required.

Treatment will depend on the underlying cause of the pain.

Foot pain cannot always be prevented, but practicing good foot care can help. People should aim to do the following:

• Ease into exercise: Many foot injuries occur when a person does too much, too soon. Exercise should gradually increase in time and difficulty.
• Warm up and cool down when exercising: Stretch muscles in the feet and calves gently once muscles are warm.
• Rest the feet: Muscles and joints can benefit from a day off, especially for those who do a lot of running, sports, or high-impact activities. A person can consider alternating with low-impact activities, such as swimming, yoga, or strength training to protect their feet from injury.
• Wear supportive shoes: This is especially important for people with diabetes or arthritis. Shoes that fit properly and provide support can help prevent pain from overuse, sprains, and strains. They can also help prevent slips and falls.

People should also avoid going barefoot and replace shoes when they begin to look worn or become uncomfortable.

Feet work hard to support and move the body each day, so any foot pain should be addressed right away to prevent it from getting worse.

Most causes of top of the foot pain can be treated with non-invasive methods, such as rest and stretching.

Foot pain that is caused by a health condition should be managed by a doctor.