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So you are leisurely walking and suddenly have to stop because you feel a sharp pain on the top of your foot. You may think to yourself “What could it be”?
The human body is complex. Your feet undergo a lot of stress and strain daily. Your feet have bones, ligaments, tendons, muscles, and nerves in them. If you experience pain on the top of your foot from walking, there could be a few reasons why.
Let’s dive in…
1) Extensor Tendonitis
Our bodies have tendons in them that connect the muscles to the bone. When a tendon in the foot gets inflamed, usually secondary to overuse or ill-fitting shoes, it’s called “tendonitis”.
The tendon that courses over the top of your foot that is responsible for helping your foot and your toes move in an upward direction is called the extensor tendon. This tendon actively fires when you walk.
Causes of Extensor Tendonitis
- Walking on incline
When you walk for a long time on an incline (uphill) you may be over-firing the extensor tendons and may notice an achy pain on the top of your foot. You may experience some discomfort along with swelling when this occurs.
- Wearing ill-fitting shoes
Since the extensor tendon courses along the top of your foot, wearing tight shoes that are compressive can cause pain.
Even tying your shoelaces too tight can cause pressure and discomfort over the tendon. This can cause it to become inflamed with prolonged walking.
Read more about how bad shoes can affect foot pain here.
- Overuse
If you recently started a new workout regimen and have suddenly increased your activity, this could trigger extensor tendonitis. Also, suddenly increasing the distance you walk can cause extensor tendonitis as well.
Diagnosis
Extensor Tendonitis is usually diagnosed clinically with a physical exam. There may be swelling and dull, achy pain present on the top of your foot.
It’s important to remember that because the extensor tendon is not a bone, it cannot be visualized in detail on an x-ray. However, an x-ray should be ordered regardless to rule out a stress fracture, which can have similar symptoms.
If your doctor is worried that there is a tear in the extensor tendon, an MRI can be ordered.
Treatment
Extensor Tendonitis should be treated primarily with RICE therapy.
- Rest
You should take a few days off of your foot to rest. If you simply cannot stay off your foot, you can try cross-training activities such as swimming or yoga.
- Ice
Icing your foot can help prevent pain and discomfort in the foot
- Compression
You can wrap your foot using an ACE bandage to help with the swelling and discomfort.
Compression stockings are also very beneficial to reduce swelling. I prefer the Jobst Activewear 20-30mmHg compression stockings. Make sure that you measure your ankle and calf circumference to find out your exact size before ordering.
You should wear the stockings during the day, and remove them at night. You can wash them and reuse them.
One pair of stockings is usually good for 6 months of compression.
- Elevation
Elevating your foot using a couple of pillows is also helpful to relieve the throbbing and achy pain you may experience.
You will also want to find appropriately-fitted shoes at your local running shoe store. Make sure to wear shoes that fit properly and are extra-depth. This means that the top part of the shoe should not be compressing on the top of your foot.
Occasionally, if the extensor tendonitis is severe, your doctor may recommend physical therapy to help decrease pain and improve strength along the tendon.
Tight calf muscles can also cause extensor tendonitis. Appropriate stretching and strengthening can help with the pain and discomfort associated with extensor tendonitis.
Your doctor may also prescribe anti-inflammatory medications like NSAIDs to help with the discomfort. Very rarely would you require a walking boot if there’s no underlying fracture.
Prevention
- Make sure to not increase your activities too soon. If you experience pain on the top of your foot from walking quite regularly, it may be time to scale back.
- Make sure to perform stretching exercises before and after your activities.
- Make sure that your shoes fit properly. Again, it’s best to go to a running shoe store or your foot doctor to get your feet measured and get recommendations about which shoes would be best for you.
2) Stress Fractures
If you experience pain on the top of your foot from walking you may have a stress fracture. Stress fractures are small cracks in the bone that can occur due to repetitive pressure in a specific area.
The most common area to develop a stress fracture in the foot is the 2nd metatarsal bone. Stress fractures can be seen in any bone. Occasionally, it can occur in the 5th metatarsal base. These fractures are called “Jones fractures” and can be difficult to heal due to the poor blood supply present in the 5th metatarsal base.
Diagnosis
If you have a stress fracture in your foot, you may experience dull and achy pain on the top of your foot. You may also notice subtle swelling and difficulty bearing weight on the foot.
Your doctor will order an x-ray at your visit, and again 3-4 weeks later, as stress fractures are often not visible on x-ray until a few weeks after the initial onset of pain.
Treatment
If your doctor finds that you have a stress fracture in your foot, he/she may recommend that you walk in a cast boot for six to eight weeks until the fracture is healed. If the fracture fragments are shifted (displaced), it may require surgery.
This United Ortho short cast boot is great because it stabilizes the foot and ankle appropriately. Also, its a short cast boot, and easier to wear. The tall cast boots can sometimes be cumbersome.
Prevention
It’s important not to increase activities too soon. Not undergoing proper training and warm-ups can lead to a stress fracture. It’s also important to wear well-fitted shoes that don’t cause excessive pressure to be placed in one area of the foot.
If you want my detailed guide on how to treat foot stress fractures, you can read my blog post about stress fractures here.
Sinus Tarsi Syndrome
The sinus tarsi is a tunnel where the ankle bone meets the heel bone. There are ligaments inside the sinus tarsi, as well as fatty tissue. When someone has a flatfoot foot structure or a “pronated” foot structure, the sinus tarsi can be pinched. Scar tissue can form inside the area and cause pain.
When walking, you may experience pain on the top of your foot and outside of your ankle. You may also notice swelling in the ankle and on the top of your foot
Diagnosis
Your doctor will perform a physical exam and order an x-ray to evaluate your foot structure. If the pain is severe, an MRI may be ordered. This can confirm when inflammation of the sinus tarsi is present.
Treatment
- Orthotics
Orthotics help increase arch support and prevent pain and impingement of the sinus tarsi. Custom orthotics would be ideal.
Orthotics will need to be placed in your shoes when walking.
If you choose to purchase an orthotic online, I would recommend the Powerstep Protech insert. These are good because they have a firm arch support that feels comfortable. Also, the heel cups on the inserts are deep, which is a plus.
The deep heel cup helps stabilize your heels when walking. In addition, the heel has a “poron” component, which helps with shock absorption when you walk.
Depending on how much you walk, these inserts can last anywhere from 6 months to 1 year.
Make sure you remove your shoe liners before putting the inserts in your shoes. They work best in athletic shoes.
- NSAIDS
If you have pain and inflammation secondary to an impingement in the sinus tarsi, your doctor may suggest taking NSAIDs such as Motrin to help alleviate your discomfort.
- Steroid injection
Steroid injections can be effective in reducing pain and inflammation at the sinus tarsi. You can continue your activities after receiving a steroid injection in your ankle. No downtime is required. You can check out Kevin Kirby’s video on how a sinus tarsi injection would be performed.
- Physical therapy
Physical Therapy can help to reduce pain and also improve stability at the ankle joint. When you have sinus tarsi syndrome, you may struggle with balance issues and weakness. Physical therapy can help to strengthen the foot and also improve balance.
- Surgery
When pain is persistent, your doctor may consider surgery. This is rare and is usually a last resort. Your doctor will remove the scar tissue present in the sinus tarsi using an ankle scope or via an open surgery.
Prevention
Make sure you are wearing well-fitted shoes with appropriate arch support to prevent sinus tarsi syndrome from developing.
3) Midfoot Arthritis
If you experience pain on the top of your foot from walking, you may be experiencing pain secondary to midfoot arthritis. Arthritis can be present in the midfoot joints. The most common area arthritis is seen is in the metatarsocuneiform joints.
Midfoot arthritis can cause dull, achy pain to be present on the top of the foot. Constant irritation to the midfoot joints over the years can cause bone spurs to form on the top of your foot. The bone spurs can then aggravate the nerves that cross the top of the foot.
If you have pain in the top of your foot that occurs from walking, your shoes may be compressing the top of your foot, which can cause shooting pain to occur in your toes.
Diagnosis
Midfoot arthritis can be diagnosed with an x-ray. Your doctor will be able to visualize spurring present on the x-ray.
Your doctor may also tap on the nerves on the top of your foot to see if you experience shooting pain that goes into your toes. This is suggestive of nerve irritation.
Treatment
- Orthotics
Your doctor may suggest orthotics to keep the midfoot stabilized. Even micro-motion in arthritic joints when walking can cause discomfort.
- Stiff-sole shoes
When suffering from midfoot arthritis, it is best to wear shoes that have a stiff sole on the bottom. Flexible shoes can cause too much motion to occur in the joints and thus cause pain.
- Voltaren gel
NSAID gels such as Voltaren 1% gel can help to reduce pain and discomfort in the foot. This gel with help reduce the dull, and achy feeling in your feet. Avoid using while taking other NSAIDS.
- Steroid injection
Steroid injections can be very effective in alleviating pain secondary to arthritis. Your doctor may inject a steroid into your midfoot joint. The steroid injection will also help with the associated nerve pain and inflammation.
It’s important to remember, however, that steroid injections will not resolve arthritis. It is simply used to reduce pain and inflammation.
- Surgery
If the pain associated with your midfoot arthritis and neuritis is severe, your doctor may suggest surgery. Your doctor may choose to remove the bone spurs that cause pain. You can read more about resecting bone spurs in the midfoot in my article written in the Journal of Foot and Ankle Surgery.
Your doctor may also choose to fuse your midfoot to prevent motion in the area. If you undergo a midfoot fusion, you will need to be off your feet for 6-8 weeks afterward.
Prevention
There is not much you can do to prevent arthritis, but you can certainly wear stiff supportive shoes and inserts to help manage your symptoms.
Read more about Simple Solutions To Manage Foot Arthritis in this supplemental blog post.
5) Ganglion Cysts
If you experience pain on the top of your foot from walking, you may have a ganglion cyst.
A ganglion cyst is a benign cyst that can form on the top of the foot. It can occur secondary to micro-trauma at the joint surface or along a tendon sheath.
Generally, these cysts are not painful unless they are pressed upon or become large enough where they impinge on a nerve.
If you regularly experience pain in the ganglion cyst on the top of your foot from walking, you will need to get it treated.
Diagnosis
Ganglion cysts can be diagnosed with aspiration or with an MRI. An MRI would allow for visualization of the bones, muscles, and tendons. An MRI would be useful to rule out other kinds of soft tissue masses and malignant tumors.
An aspiration of the ganglion cyst can be performed as well. Your doctor will numb the area surrounding the cyst with a local anesthetic. He/she will then use a larger needle to aspirate the cyst. A jelly-like fluid is expressed.
Here’s a great video of a ganglion cyst aspiration performed by Dr. Wagner at Jaws Podiatry. Make sure to check it out.
Aspirating a ganglion cyst can help for diagnostic purposes and also serve as treatment for the cyst. If aspirated appropriately, the cyst site will be flat afterward. This will reduce pain.
It’s important to realize, however, that recurrence rates are high after cyst aspiration.
Surgery
If the ganglion cyst continues to cause pain, your doctor may surgically remove the cyst. Depending on the location of the cyst and the size of the cyst, your doctor may allow you to bear weight after the surgery in a special post-op shoe for a few weeks. Once healed, you can resume walking.
Prevention
You can’t necessarily prevent a ganglion cyst, but you can try to avoid irritation to the cyst. Make sure to wear well-fitted shoes that don’t rub against the top of your foot.
If you have a small ganglion cyst on the top of your foot, donut-shaped offloading pads may be helpful to offload the cyst from the top of your shoes.
Conclusion
Foot pain can be so frustrating, especially when it occurs from walking. It’s natural to want to walk through the pain. However, it’s important to understand that sometimes resting the foot may be necessary.
If you want to stay active, you can try cross-training activities such as swimming, yoga, or biking.
Increasing the duration and intensity of exercises can aggravate pain on the top of your foot. If you notice persistent pain on the top of your foot despite changing your shoes/inserts and modifying your activities, it’s time to contact your doctor.
The last thing you want to do is injure your foot further.
Getting an accurate and early diagnosis with appropriate treatment is important to ensure that you can continue walking without pain.
Have you ever experienced foot pain from walking? What did you do to treat it? Did it help? I’d love to hear your thoughts!
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