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Houston podiatrist discusses causes of pain on top of your footThere are many causes of pain in your feet. One of the least understood is when the pain occurs on top of your foot. My name is Dr. Andrew Schneider, and I'm a podiatrist in Houston, TX. We have names for various areas of the foot. Other than "dorsal surface", there is none that describes the top of the foot. 

There are a number of reasons why you can get pain on the top of your foot. Many people discount when they have this kind of pain, since they just assume that their foot got stepped on and they don't remember it.

One cause of pain on top of the foot is extensor tendonitis. The extensor tendons travel across the front of your ankle and the top of your foot. These are the tendons coming from the muscles that are involved if you have shin splints. The mechanism of these tendons becoming inflamed is essentially the same. Like treating shin splints, I might consider an oral anti-inflammatory medication. Unlike shin splints, we also can consider a cortisone injection when the inflammation is in your foot or ankle. 

Extensor tendonitis is usually caused by overuse and instability. The best way to address an unstable base of support is with the use of a custom orthotic. An orthotic will provide stability and efficiency to the feet and ankles. That stability will balance the tendons, making them work less. That's why a custom orthotic is the best long-term treatment to help you prevent tendonitis from continuing to come back. 

Another cause of pain on the top of the foot is a bone spur. A bone spur can form on the top of the midfoot, since it's a high area of pressure. It's particularly common in people with high arch feet. When a spur forms, you'll notice a bump on the top of your foot. This gets irritated by the top of your shoes. Depending on the shoes you wear, there could be significant pressure on your foot. In cases where you have a bump on top of your foot due to a bone spur, it's commonly treated by removing the bone spurs surgically. It's a pretty straightforward procedure and
recovery. In most cases, the relief is immediate. 

When we think of sprains, we often think of a sprained ankle. The foot can be sprained as well. A sprain is a partial or complete tearing of the ligaments that support the foot. I see lots of foot sprains caused by sports like soccer, tennis, and basketball. In all of these sports, you plant your foot and twist. Twist too much and you can injure your foot. After I take an x-ray in the office to ensure nothing's broken, we address this sprain. A foot sprain can cause swelling, pain, and bruising. I'll recommend that you immobilize your foot for a short time in a surgical shoe or boot. We'll also use ice and anti-inflammatory medication to reduce the inflammation and pain. When you sprain your foot, you'll have to take some time off exercise. In most cases, it's just a couple of weeks, but it may maybe longer if the injury takes longer to heal. 

The next cause of pain on top of your foot is a stress fracture. It is common to have a stress fracture in the metatarsal bones because of the excessive load during activity and exercise. In fact, this is one of the greatest dangers of exercising on a harder surface. A stress fracture is a break in the bone that is not displaced. Sometimes it's referred to as a hairline fracture. But don't let that make you take it any less seriously than any other type of broken bone. A stress fracture needs to be immobilized and you need to stop activity. If you continue to run, or don't properly treat a stress fracture, then it can become displaced and, at best, will require a longer recovery. And at worst, we will require surgery to properly repair the broken bone. 

You can expect to be immobilized for six to eight weeks with a stress fracture. Even so, you won't go back to activity and exercise until at least 12 weeks after the injury. I need to know the bone is strong enough to support you when you work out. It doesn't make sense to go back to exercising sooner, only to be injured again right away.