28 Causes of Pain on Top of the Foot (And What to Do)

What are the different symptoms of pain on top of the foot?

First, I will discuss the most common sensations experienced when you have pain on top of the foot, along with the most likely causes of this pain each time.

Sensation	Explanation
Pain on top of the foot when walking	Walking causes muscles to contract and puts more weight on the foot, which can trigger or increase pain, regardless of its cause. It could be a simple overuse syndrome (you’ve overdone it) or any other type of cause (see further).
Swollen and painful top of the foot	The foot can swell due to trauma, inflammation, an allergy, circulation problems, or just because you’ve overexerted it. Swelling doesn’t give us a clear indication of the cause.
Pain on top of the foot at rest	The fact that pain occurs at rest doesn’t give much indication of the possible cause. Any of the causes listed later could potentially trigger pain at rest.
Painful bump on top of the foot	If you didn’t have a bump before in that spot and you haven’t had any trauma, it could be due to a circulation problem (especially if the bump is soft), or it could be an exostosis, especially if the bump is hard. An exostosis is a bony growth that appears for reasons we don’t quite understand.
Burning sensation on top of the feet	When experiencing burning or tingling sensations, it could be due to nerve problems (in the foot, or higher up in the back in cases of sciatica). Sometimes, it’s just simple inflammation causing this sensation.
Impact on top of the foot	The impact may have caused a simple contusion, a fracture, or a sprain.
Pain on top of the foot at night	Pain that occurs mainly at night is often inflammatory pain, caused by inflammation. Many foot problems can cause inflammation: fracture, sprain, tendinitis, osteoarthritis, etc.
Pain on top of the big toe, pain in the upper foot, pain behind the foot above the heel, pain on top of the ankle, pain in the tendon on top of the foot	When the pain is localized in a specific area and increases while walking or when you move the foot upwards, it might be a tendon problem at the tendon passing through that area.
Pain on top of the big toe	Tendinitis of the big toe lifter (quite common).
Pain in the upper foot, tendon on top of the foot	Problem with the extensor digitorum longus.
Pain behind the foot above the heel	Problem with the Achilles tendon (tendinitis or partial or complete rupture of the Achilles tendon).
Pain on top of the foot upon waking	Pain felt on the upper part of the foot upon waking, which could be related to joint or muscle problems or other medical conditions.
Pain in the left or right foot	The fact that it’s your left or right foot doesn’t provide any additional clues about the possible cause.
Swollen vein on top of the foot	A vein may occasionally swell more than usual without a specific problem, such as due to heat or more intense physical activity.
Running pain on top of the foot	Pain on top of the foot is very common in running. It can be due to simply a shoe that’s too tight on top or overtraining. Less often, it could be a tendon problem or a stress fracture.
One foot swollen on top	I’ve already dedicated a full article to this subject.

It is, of course, very difficult to identify the cause of pain based solely on how it feels.

Later on, I will provide more insights to help you identify the meaning of this pain on your own.

First, I will detail the most common causes of pain on the top of the foot.

What are the 28 most common meanings of pain on top of the foot?

To determine the most common causes of pain on the foot, I based my findings on three things:

• my own experience as a physical therapist;
• the most searched keywords on Google related to “pain on top of the foot”;
• some scientific publications (links at the end of the article).

Know that this type of problem is very common: up to 8% of people who consult a general practitioner do so because of foot pain (Gates 2019)!

And when people are randomly asked if they had foot pain in the past month, studies show that 13% to 36% of people answer yes (Gates 2019)!

Here are these 30 likely most common causes:

Causes of Pain on Top of the Foot	What Is It?
🥇 Reaction to Overactivity	The body’s response to excessive strain, resulting in temporary inflammation. For example, due to spending more time standing, walking, or running, you may have increased your activity level too quickly for your foot to handle.
🥈 Friction, Temporary Irritation	Generally caused by uncomfortable shoes, leading to temporary irritation.
Metatarsal Fracture	A break in one of the metatarsal bones (there are 5, along each toe), usually due to trauma or overuse. The most common is the fracture of the 5th metatarsal.
🥉 Tendinitis of One or More Extensor Muscles of the Foot	Inflammation of the tendons responsible for extending the foot, often due to overuse. ++ Especially the long extensor of the big toe, long extensor of the toes.
Ankle Sprain (or Simple Twisted Ankle)	Stretching or tearing of the ankle ligaments after a twist or fall.
Ligament Injury (Other than Ankle Ligaments)	Injury to ligaments other than those in the ankle. For example, Lisfranc or Chopart sprains.
🥉 Metatarsalgia	Pain and inflammation in the metatarsal region, often due to excessive pressure or overuse, without actual bone or tendon problems.
🥉 Arthritis, Osteoarthritis	Inflammation of the joints or wear of the cartilage.
Gout / Other Inflammatory Diseases	Accumulation of uric acid crystals in the joints / Joint damage in the context of rheumatoid arthritis or ankylosing spondylitis.
Compartment Syndrome	Increased pressure in muscle compartments, causing pain due to poor circulation.
Morton’s Neuroma / Syndrome	Thickening of the nerve between the metatarsal bones, causing pain or numbness.
Bursitis	Inflammation of bursae, small fluid-filled sacs.
Achilles Tendinopathy	Irritation and inflammation of the Achilles tendon, located at the back of the ankle.
Hammertoe Syndrome	Toe deformity.
Shin Splints	Inflammation of the tendons around the ankle.
Synovitis	Inflammation of the synovial membrane (present in every joint).
Exostosis	Abnormal bone growth, causing a painful bump on top of the foot.
Accessory Navicular (Os Trigonum)	Extra bone at the back of the foot.
Stress Fracture of a Foot Bone	Small fracture due to overuse, usually in athletes or active individuals.
Ganglion Cyst	Small fluid-filled bump.
Plantar Fasciitis / Heel Spur	Inflammation of the plantar fascia, causing heel pain, under the foot (and sometimes radiating to the top of the foot).
Claw Toe	Toe deformity.
Lenoir’s Spur	Small bony growth, usually on top of the foot.
Osteochondritis Dissecans	Detachment of a part of the articular cartilage.
Nerve Compression	Pinching or compression of a nerve, causing pain along the affected nerve.
Ischemia or Vascular Insufficiency	Reduced blood supply to the foot.
Bunion (Hallux Valgus)	Deviation of the big toe joint, causing a painful bump on the side of the foot.
Tarsal Tunnel Syndrome	Compression of the posterior tibial nerve, causing pain and numbness.

Are you feeling overwhelmed by all these possible causes?

Let me help you identify the cause of YOUR pain on top of your foot.

How to Determine What’s Causing Your Foot Pain

Here are some questions to help you pinpoint the most likely cause of your foot pain.

1️⃣ How long have you been in pain? And after what event?

• A few days? Weeks? Months, years, but it fluctuates?

By asking yourself this question, you can likely identify if one or more events triggered this pain.

Here are the most common triggers:

• You had a foot injury: You might have a simple contusion (which doesn’t require specific treatment), or less commonly, a fracture.
• You twisted your ankle: You might have an ankle sprain.
• You changed your shoes: Some shoes rubbing on the top of your foot can cause simple inflammation.
• You changed your lifestyle: More sports, new job, more time standing at home, etc. In this case, you might have simple overuse or a tendon issue (tendinitis, tendinopathy). Less commonly, a stress fracture.
• You can’t identify a specific trigger? It’s probably not one of the issues listed in 1, 2, 3, or 4.

2️⃣ Does your pain increase or only occur when you move your foot a lot or when you walk or exercise?

In this case, it’s more likely you have a tendon issue (tendinitis, tendinopathy), or simple overuse.

Osteoarthritis can also cause pain that occurs mainly when you are active.

3️⃣ Do you have a visible bump or deformity around your toes or on your foot?

In this case, it’s more likely you have a bunion, an exostosis, or one of the various foot deformities mentioned earlier.

When should you see a doctor for pain on top of your foot?

Very often, while browsing the internet or reading magazines, you’ll come across articles that say something like, “if in doubt or concerned, consult your doctor.”

My aim here is not to repeat this frequently seen phrase, even though I understand that many health and medical writers use it. Instead, I want to be as specific as possible in advising you on when to consult a doctor or not.

In the vast majority of cases, pain on top of the foot that did not result from a shock, fall, or trauma does not require an immediate consultation.

You can simply mention the issue to your primary care physician during your next scheduled visit for something else, if it still concerns you at that time.

Other symptoms associated with this foot pain might, on the contrary, prompt you to consult a doctor, though not urgently.

These symptoms are:

• If you have great difficulty walking while putting weight on the foot, if you are unstable, or if walking is extremely painful;
• If you have an unexplained fever not related to an ongoing illness like the flu or a bad cold;
• If your skin has rapidly changed color, becoming purplish or very red;
• If you have lost a lot of weight recently or feel generally very unwell.

How to relieve and treat pain on top of the foot?

There are basically two main approaches to treating foot pain:

identify its cause and treat it;
simply relieve the symptoms (pain, swelling), regardless of the cause.

There are almost infinite medical or surgical treatments, non-drug approaches, or home remedies proposed to relieve foot pain.

Some have been evaluated in clinical studies on healthy adults or within the context of specific conditions, while others have not.

List of solutions to relieve pain on the top of the foot

Here is an overview of these treatments often suggested by professionals:

• Apply cold, use cryotherapy;
• Undergo pressotherapy sessions;
• Wear class 2 compression stockings (see an example on Amazon). Sometimes, a reduction in the volume of the lower limbs is observed in healthy individuals who wear them (Sugahara 2018). Some conditions contraindicate the use of compression stockings.
• Practice manual lymphatic drainage or other manual massages or use a device;
• Use shock wave therapy;
• Resort to ultrasound;
• Wear a splint/brace, get strapping or other compressive bandages applied;
• Elevate the leg (foot higher than the heart), keep it elevated;
• Avoid prolonged static standing, overly dynamic walking, or any other activity that aggravates the pain;
• Take painkillers or anti-inflammatory medications;
• Perform regular ankle movements, especially dorsiflexion and plantarflexion;
• Get an injection (corticosteroids, hyaluronic acid, etc.);
• Undergo surgery;
• Apply essential oils or creams.

Etc., etc.

How to choose from this list (which is, moreover, incomplete)? Should you test each treatment one by one, or try several at the same time?

What I Recommend Doing

Here’s how I usually reason for myself and my patients in situations where there are many possible treatments, but few that seem to stand out significantly.

I choose based on these four criteria (yours may be different!):

☑️ Maximum effectiveness (theoretical/empirical);
☑️ Minimum side effects;
☑️ Minimum cost (in time, energy, money);
☑️ Minimum dependency on another person or equipment.

For example, this automatically eliminates invasive procedures like injections for me: no significant evidence of effectiveness compared to a placebo, costly to implement, and risks of side effects such as infection.

I also eliminate shock wave therapy because the theoretical mechanism of action on pain is inconsistent, and it requires visiting a professional with the equipment or purchasing expensive equipment oneself.

You may be surprised by my recommendations. Perhaps you have been advised to try another treatment. Often:

• Physical therapists will recommend exercises, shock wave therapy, pressotherapy, etc.;
• Rheumatologists will suggest medications or injections;
• Surgeons will propose surgical interventions under anesthesia;
• Osteopaths will recommend osteopathy sessions.

What’s the common point? Each healthcare professional will likely recommend something they practice themselves.

This is something to consider when consulting any professional 🙂.