Top of Foot Pain: Symptoms, Causes, and Treatment

With its 26 bones, 30 joints, and over 100 ligaments, muscles, and tendons, the foot is an extremely intricate structure. Because of this complex nature, it can be difficult to determine the exact cause of pain on the top (dorsal) part of the foot.

Paying attention to the details of your condition can help you get to the bottom of the soreness.

This article will detail the most common causes of pain on the top of the foot, the typical symptoms accompanying it, and the various treatments available for it.

Low section of young woman massaging her foot

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Dorsal Foot Pain Symptoms

Depending on the origins of your dorsal foot pain, several other corresponding symptoms may also be present in this area. These include, but are not limited to:

  • Redness or warmth in the forefoot or toes
  • Extreme sensitivity and difficulty putting on a sock or shoe
  • Swelling in the foot, ankle, or toes
  • A palpable nodule on the top of the foot
  • Limited range of motion in the foot or toes
  • Difficulty standing, walking, or climbing stairs
  • Numbness or tingling in the foot or toes 
  • Bruising on the bottom of the foot

Some of these symptoms are unique to a particular diagnosis, while others can be seen with numerous causes of dorsal foot pain. A formal evaluation by a healthcare provider is the most accurate way to determine a true diagnosis. That said, keeping track of your symptoms and when they originated can help you hone in on the potential cause of your condition.

Causes of Top of Foot Pain

While many conditions can lead to pain on the top of the foot, several are more common. The typical causes of this issue can generally be divided between acute (or repetitive) injuries and more chronic health concerns. Among the more frequently seen acute causes are:

When talking about dorsal foot pain from a more chronic medical condition, the most common causes are:

Injuries to the top of the foot usually happen during a distinct painful event or due to excessive repetitive activities (like running). For example, Lisfranc injuries occur when the midfoot joints dislocate after the ligaments in this region are torn. This injury commonly happens when the foot is in a downward pointed (plantarflexed) position, and someone lands on top of it. It can also occur after an auto accident or a fall.

Overuse injuries usually occur over time after the volume or intensity of a repetitive activity (like running or jumping) is quickly increased. This can include extensor tendonitis, where the tendons that help lift the foot and toes become overused and painful, or metatarsal stress fractures, where a small crack gradually develops in one of the bones at the base of your toes.

In the case of chronic health conditions that lead to dorsal foot pain, the causes are more varied. For example, gout is a form of inflammatory arthritis that leads to sudden, severe pain in the foot or base of the big toe. This condition occurs when high levels of uric acid cause a buildup of irritating urate crystals in a joint.

Midfoot osteoarthritis, on the other hand, is a more localized version of arthritis. This arises when degeneration in the smooth articular cartilage at the ends of the foot bones causes a gradual increase in friction, swelling, and soreness in the region.

Peripheral neuropathy can have numerous causes. Among the most common is diabetes; however, hormone imbalances or kidney dysfunction can also be to blame. This issue can lead to intermittent pain or cramping in the midfoot, along with numbness, tingling, weakness, loss of sensation, or even balance impairments. As it progresses, this condition can ultimately affect numerous parts of the body at the same time.

Finally, the causes of ganglion cysts are not entirely clear. This fluid-filled prominence develops gradually and can occur in many places, including the top of the foot. While typically asymptomatic, occasionally the cyst can cause tingling if it presses on a nerve or soreness if it contacts a tendon or joint.

How to Treat Top of Foot Pain

Some conditions that cause pain on the top of the foot can be treated with common at-home remedies. For example, avoiding irritating activities and using ice and NSAID medication can help improve the symptoms of extensor tendonitis or midfoot arthritis. This same treatment is also commonly needed for metatarsal stress fractures, along with using crutches to avoid weight-bearing through the injured area.

Other conditions require the use of prescription medications. A gout flare-up, for instance, is typically treated with colchicine, a medication that helps lower uric acid levels, or oral steroids. Certain classes of medication, including anti-seizure, antidepressant, and antiarrhythmic drugs, are also commonly used to address peripheral neuropathy.

Finally, a more invasive intervention may also be utilized for your dorsal foot pain in certain situations. For example, the pain from gout or midfoot arthritis is occasionally severe and needs to be treated with a pain-relieving cortisone injection. Surgeries may also be needed in some cases, including many types of Lisfranc injuries, and infrequently for midfoot arthritis or certain types of stress fractures.

Orthotics (shoe inserts) may also be used along with Voltaren gel to help alleviate some of the pain.

Are There Tests to Diagnose the Cause of Top of Foot Pain?

Diagnosis of dorsal foot pain typically begins with a comprehensive evaluation by a physician. During this examination, several tests can help your healthcare provider discover the root cause of your issue:

  • X-rays and MRIs: These tests are useful for visualizing bone and soft tissue conditions like midfoot arthritis, a stress fracture, a Lisfranc injury, or extensor tendonitis. This type of imaging may also be used for a ganglion cyst, though this is rarer.
  • Blood Draws: Assessing your body’s uric acid levels using a blood draw may be necessary if gout is suspected.
  • EMG: This test assesses how well the nerves in your leg and foot are functioning and can help diagnose peripheral neuropathy.

When to See a Healthcare Provider

Any new or worsening pain on the top of the foot should be examined by your healthcare provider as soon as possible. While at-home remedies may help alleviate your symptoms, this improvement may be temporary. In addition, some diagnoses like a stress fracture, gout, or peripheral neuropathy may progress or worsen if treated inappropriately.

Because of this, it is important to seek the care of a healthcare provider if you are experiencing any of the symptoms detailed above. This is especially important if you have other health conditions like diabetes, osteoporosis, kidney dysfunction, or vitamin or hormone deficiencies which can exacerbate some of the conditions that cause pain on the top of the foot.

Summary

Top of the foot pain can be caused by many things, including chronic health conditions and more acute injuries. Along with soreness, other symptoms like swelling, stiffness, numbness, tingling, or bruising may also be present in the region.

A wide variety of treatments like anti-inflammatory medication, activity modification, injections, or even surgery may be needed depending on the underlying source of your condition. Due to the numerous potential causes, a healthcare provider should evaluate any new or worsening dorsal foot pain. 

A Word From Verywell

Dealing with pain on the top of the foot, especially if it appears suddenly or is intense, can be an unnerving experience. However, while your mind may immediately go to the worst-case scenario, dorsal foot symptoms can be easily and effectively treated in many situations.

Tell your healthcare provider about your situation if you experience an acute injury or a new onset of pain in this area. Following a comprehensive examination, they’ll be able to guide your recovery from this sometimes disabling issue. 

Frequently Asked Questions

  • Does a midfoot injury require surgery?

    In many cases, injuries that affect the midfoot can be managed conservatively with activity modification, physical therapy, or pain medication. This is true for issues like metatarsal stress fractures, a low-grade Lisfranc injury, extensor tendonitis, or a flare-up of midfoot arthritis. However, some more severe Lisfranc injuries or stress fractures, as well as midfoot arthritis that does not respond to initial treatments, may require surgery.

  • Is peripheral neuropathy curable?

    Most cases of peripheral neuropathy cannot be cured. Fortunately, there are many things that can be done to help manage the symptoms of this condition. This may include prescription medication, lidocaine patches, or a pain-relieving injection or nerve surgery. 

  • Could the pain in the middle of my foot be gout?

    While gout most commonly affects the outer base of the first toe, it can also target the foot or ankle regions (along with many other joints in the body). The pain from gout is typically sudden and severe in nature, often appearing for the first time at night. The affected area is also frequently stiff, warm, and swollen. Gout symptoms should be reported to a healthcare provider immediately to initiate treatment.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Khanna PP, Gladue HS, Singh MK, et al. Treatment of acute gout: a systematic review. Seminars in Arthritis and Rheumatism. 2014;44(1):31-38. doi:10.1016/j.semarthrit.2014.02.003

  2. American Association of Orthopaedic Surgeons. Lisfranc (midfoot) injury.

  3. American College of Foot and Ankle Surgeons. Ganglion cyst.

  4. Johns Hopkins Medicine. Peripheral neuropathy.

  5. American Association of Orthopaedic Surgeons. Stress fractures of the foot and ankle.

  6. American Medical Society for Sports Medicine. Extensor tendinopathy.

  7. Massachusetts General Hospital. Midfoot arthritis.

By Tim Petrie, DPT, OCS
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.