There are a number of causes of dorsal foot pain (pain around the top of the foot). This information sheet summarises the most common causes, looking at the symptoms and treatment options for each type of pain.
Stress Fractures
Cause
Stress fractures are the most common cause of dorsal foot pain. A stress fracture is a small break in one of the bones in the foot. They are normally caused by repetitive overloading of the foot. They are common in runners and often occur in cases where there is a sudden increase in activity. Stress fractures are often associated with muscle tightness, weakness or imbalances in the muscles of the foot and lower limb.
Symptoms
The symptoms of a stress fracture are localised pain and swelling. The pain often becomes worse over time.
Treatment
Stress fractures are treated by resting the foot and reducing inflammation. You may require crutches or a brace. Treatments include icing the affected area, anti-inflammatory medication (in conjunction with your GP) and surgery (only rarely).
Extensor tendonitis
Extensor tendonitis is caused by inflammation or irritation of the tendons that pull the toes up. This is often caused by friction or compression from a poorly-fitting shoe.
The tendons sit between the skin and the bones and there is little padding around them, making them prone to injury.
Cause
It tends to affect people who spend long periods on their feet, keen cross-country runners and people who lace their shoes too tightly.
Gait and foot biomechanics play a key role in the development of extensor tendonitis. People with high arched feet are more likely to have pressure on the top of their foot.
People with a pronated foot position may find their extensor tendons and the intrinsic muscles of the foot under high levels of stress. Calf tightness may also contribute to extensor tendonitis.
Symptoms
The symptoms of extensor tendonitis tend to be confined to the top of the foot, occasionally spreading to the arch of the foot. Pain tends to be worse with activity and better with rest. The foot may appear swollen or bruised and the top of the foot maybe tender to touch.
Treatment
- Changing the lacing of your shoes is a simple, but effective method to reduce pressure on the inflamed area. Either tie your knot at the side or miss out one of the lacing holes.
- Rest. Avoid strenuous activities for a period and allow the tendon time to heal.
- Ice the painful area regularly. This will reduce pain and inflammation.
- Anti-inflammatory medication such as ibuprofen (to be taken in consultation with your GP)
- Orthotics: If there is a biomechanical factor to your condition, an orthotic insole can reduce tissue stress, provide padding and support the foot. This will alleviate undue tension on the tendons.
- Strengthening exercises for the extensor muscles help to improve strength and endurance. Calf stretches can also help as having tight calves puts more strain on the extensor tendons
- Steroid Injections can be given to help reduce the inflammation if the pain does not respond to treatment. This is not a recommended 1st stage treatment as the injections may weaken the tendon.
Neuritis
Neuritis is impingement of the nerves providing sensation to the top of the foot. When the sensory nerve branches are compressed, the top of the foot can experience a range of sensations including stabbing pain, tingling, burning or numbness.
Neuritis is most commonly caused by pressure from shoes. This condition is also commonly seen in people with a high arched foot.
Treatment for this condition is very similar to the treatment for Extensor Tendonitis. In certain cases, the conditions are observed simultaneously.
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