Top-Of-Foot Pain After Running – Causes, Treatments, and Prevention

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Top-of-foot pain after running can be caused by a variety of factors. In order to get back to running pain-free, you need to know the most likely culprit and if you can treat it at home or if you need to see a medical professional.

It’s best to treat this kind of pain immediately. These injuries tend to get worse without treatment which will only further delay your recovery.

Here are some of the most common causes of pain on the top of your foot after running.

What Is the General Treatment for Pain on Top of the Foot?

When you first begin to notice pain or discomfort on the top of your foot, the general treatment would be the combination of the following:

Rest the affected foot as much as possible. Stop or limit any activities that may cause pain. By resting the foot, you’ll allow the tissues to heal and prevent any further stress to the area.

Apply ice for 10 to 20 minutes at a time, several times a day. Make sure to wrap the ice in a towel—especially ice packs, because they’re so cold—so that you don’t irritate the skin. If the pain or discomfort increases when you apply the ice, then stop icing immediately.

Try soaking your foot in a bucket of cold water with some Epsom salts. Again, if the pain increases, stop immediately.

Wear compression socks or apply a compression bandage—ACE wrap or Tubigrip—to help reduce the swelling.

Whenever you are sitting or lying down, elevate your foot above your heart level and support it with a pillow. This will prevent excessive swelling, which could stretch the nerve fibers in the affected foot, causing more pain.

When you do have to walk, wear supportive shoes with a wide toe box. If you’re unable to place any weight on the affected foot, then you may want to use crutches and seek medical attention right away.

To help alleviate the pain and reduce inflammation, you can take an anti-inflammatory.

What if Home Treatment Isn’t Helping?

You should seek medical attention immediately if you’re unable to place any weight on your foot. If there is significant swelling, the pain is severe, or you have no feeling in your foot, visit your doctor.

If the pain hasn’t improved within 5 to 7 days, then you should make an appointment with your doctor.

Your doctor may recommend physical therapy if you have extensor tendonitis, peripheral neuropathy, or damage to the peroneal nerve.

If you have a stress fracture or a broken bone, then you may get a cast, crutches, and a walking boot for your recovery.

To help reduce the inflammation and alleviate the pain, your doctor may prescribe nonsteroidal anti-inflammatory drugs.

Common Causes of Pain on the Top of the Foot

1. Tendonitis

What Is It?

Tendonitis is when the tendons in the foot become irritated and inflamed.

The anterior tibial tendon works with the muscles in your shin to flex the foot upwards. With the repetitive motion of running, this tendon can become irritated and inflamed from overuse.

While the symptoms develop gradually, you may notice a deep achy pain on the inner front of the ankle and on the top of the foot. The pain may feel worse when you try to lift the foot or toes up.

If you press on the tendon with your fingers, the pain will get worse. Activities like walking or running—especially up hills—can make it feel worse. Your ankle may feel stiff or weak. If left untreated, it can lead to a drop foot.

Cause

The most common cause of anterior tibial tendonitis is overuse, either from excessive training, repetitive movements, or running on uneven surfaces.

If you overpronate, this will place excessive pressure on the tendon and over time the tendon becomes overstretched. This will then irritate it, leading to inflammation and pain.

Shin splints can cause tendonitis, as the anterior tibialis muscle connects to the tendon and flexes the foot upward or back toward the shin. During repetitive movements, the anterior tibialis muscle can twist abnormally, causing inflammation and pain that affects the tendon.

Wearing shoes that are too tight will place the tendon under increased stress and this can also cause tendonitis.

Treatment

Along with rest and applying ice, you should do toe grip exercises. This will help to reduce the amount of stress that’s placed on the tendon, and you’ll stretch and strengthen it.

You can wear an ankle brace or a custom orthotic to support the tendon and reduce overpronation. While you’re recovering and allowing the tendon to heal, you should avoid walking barefoot.

Walking barefoot will place the tendon under more stress and it can lead to further injuring it.

Prevention

Make sure that you’re wearing supportive shoes for your foot shape and gait. This will help reduce the amount of stress that’s placed on the tendon during your run.

Warm-up properly before every run and stretch your legs and tendons after every run. Include strengthening and stretching exercises in your daily routine, as this will help to correct imbalances that could lead to injury.

Listen to your body and don’t try to run through pain. If you have shin splints or feel as if you’re starting to develop them, act swiftly and start treating them. This will reduce the amount of stress that’s placed on the tendon.

2. Neuroma

What Is It?

Neuromas are a painful foot condition that develops when the soft tissue around the nerve that leads to toes thickens. The nerve is then placed under pressure, as there’s not a lot of space between the foot bones and the swollen nerve.

Once the nerve is irritated and inflamed, you’ll start to notice a burning sensation or a sharp shooting pain between the toes and the ball of the foot. You may even experience a tingling sensation or numbness in the ball of the foot.

When you’re walking or standing, you may feel as though you have a small stone that’s stuck inside of your shoe. Once you remove your shoe or sit down, you’ll find some relief from your symptoms.

Neuromas often affect the nerve between your 3rd and 4th toes.

Cause

Neuromas can develop from wearing shoes that are too tight or narrow in the toe box. This will place your forefoot under constant, acute pressure, as your toes are squeezed together by the shoe.

Sports activities that are high-impact, like running, soccer, and basketball, place your forefoot under pressure from the repetitive motion.

If you have high arches or flat feet, you may be at a higher risk of developing a neuroma because of the way your foot distributes your body weight.

Uneven weight distribution or instability around the toe joints will place your foot bones under excessive stress and irritate the nerve.

An injury or trauma to the foot can cause damage to the nerve, which can lead to swelling and inflammation.

Treatment

Rest your feet—follow the RICE principle—and avoid activities that are high-impact or place the neuroma under pressure. To maintain your fitness levels, try low-impact activities like swimming.

Wear shoes that have a roomy toe box so that your toes can splay naturally. This will reduce the pressure that’s placed on the neuroma and allow it to heal.

Depending on the type of arch that you have, you may need to use orthotics to help support and distribute your weight evenly. This will reduce the pressure that’s placed on the bones and the neuroma.

You can use nonsteroidal anti-inflammatory medication such as Advil, Ibuprofen, or Motrin to alleviate the pain and reduce inflammation.

Seek medical attention if you have severe pain that interferes with your daily activities. You should also see a podiatrist if the condition doesn’t improve after two weeks of at-home treatment.

Prevention

To prevent a neuroma, wear shoes that have a spacious toe box so that your toes aren’t squeezed together. Make sure that your shoes provide adequate arch support and have plenty of cushioning when you’re more active.

If the cushioning on your shoes has worn out, replace them before doing any activity. Maintain a healthy weight, as this will reduce the pressure that’s placed on your bones and joints.

Include gentle foot stretches and exercises in your routine. This will help to loosen tight tendons and ligaments while strengthening your foot. The following stretches and exercises can help prevent neuromas:

  • Figure Eight exercise
  • The Towel Scrunch
  • Toe Raise exercise
  • Manual Plantar Fascia stretch
  • The Wall stretch

3. Arthritis

What Is It?

Arthritis is a catch-all phrase that’s used to describe inflammation, swelling, and stiffness of the joints. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is when the cartilage between the joints that cushions the bones begins to wear and break down. This causes the bones to rub against each other every time you move and causes pain, swelling, stiffness, and tenderness.

Your weight-bearing joints are the most susceptible to osteoarthritis. When you develop osteoarthritis in your foot, it can cause you to lose flexibility in the limb.

Rheumatoid arthritis is an auto-immune disease that causes the body’s own immune system to attack parts of the body, especially the joints. This will cause pain, swelling, and stiffness in multiple joints.

The swelling and pain can be so severe that it affects every aspect of your life, making everyday tasks like opening a jar very difficult.

Cause

Osteoarthritis is caused by the overuse of the joint, as the cartilage breaks down. Unfortunately, osteoarthritis doesn’t just affect the cartilage but also changes the bone and connective tissues that hold the joint together.

Old injuries to the foot like dislocated joints, ligament injuries, or torn cartilage can cause osteoarthritis. But it can also be caused by joint deformities, obesity, or genetics.

Treatment

There is no cure for osteoarthritis and all you can do is treat the symptoms. One of the best ways to treat osteoarthritis is physical activity.

Exercising will help to strengthen the muscles around the joints and this can reduce pain, stiffness, and swelling. It can also help to improve joint flexibility.

Getting rest from exercise and good quality sleep will help your muscles to recover and heal, which will reduce swelling and alleviate pain.

Depending on the severity of your osteoarthritis, your doctor may recommend that you do physical therapy to strengthen the muscles.

Maintain a healthy weight, as this will place less pressure on your joints and reduce pain.

You can use over-the-counter pain relievers like Advil and Aleve to reduce swelling and alleviate pain.

You should seek medical attention if the joint pain gets worse, if you have limited range of motion, or if you experience difficulty moving a joint.

As osteoarthritis becomes more advanced, the pain, swelling, and stiffness will become more intense. By starting a treatment plan early, you can avoid permanent joint damage.

Prevention

One of the best ways to protect the joints in your feet from becoming arthritic is to wear shoes with plenty of cushioning. This will help to lower the impact of every foot strike, whether you’re walking or running, and can reduce the amount of wear and tear on joints.

If you’re an exercise enthusiast, you should consider splitting your exercise between high-impact activities like running and low-impact exercises to give your joints a break.

Sticking to a healthy diet will ensure that you get enough of the various nutrients your body needs, which can contribute to joint health. This will also help you to maintain a healthy weight, which is essential for reducing the pressure on your joints.

4. Metatarsal Stress Fracture

What Is It?

A metatarsal stress fracture is when there’s a crack—incomplete fracture—in one or more of the long bones in your foot. A stress fracture commonly occurs in the 2nd to 4th metatarsal bones.

You’ll notice swelling and pain over the top of your foot. There will be an increase in pain when walking, standing, or when you press down on the metatarsal bones.

The pain on top of the foot will subside when you rest your feet, but there will still be tenderness over the middle part of your foot.

Cause

Stress fractures are an overuse injury and are often caused by a sudden increase in the intensity of your training after you’ve had a long training break.

Wearing shoes that don’t provide adequate support for your feet, running on hard surfaces for a long time, or being overweight can cause stress fractures.

The pressure that’s placed on the metatarsal bones from overpronation, high arches, or flat feet can also cause a stress fracture.

Medical conditions affecting the bones such as osteoporosis or osteoarthritis can increase your risk of developing a stress fracture.

Treatment

The best treatment for a stress fracture is to follow the RICE principle and stop all activities that cause pain.

If the swelling doesn’t go down within 2 to 3 days, the pain is severe, or you’re experiencing numbness or tingling in the foot, then you should seek medical attention.

Your doctor may give you a boot to wear that will help protect the foot and promote healing. It would take 6 to 8 weeks for the stress fracture to heal and you should avoid activities that could place pressure on your forefoot.

Prevention

When returning to your running training routine, you should gradually increase the intensity of your runs.

Gradually increase your training intensity and distance by no more than 5 percent each week.

Make sure that the shoes you’re wearing provide adequate support, cushioning, and shock absorption for your feet. You can add strength training to your workout routine, as this will increase your bone density and prevent early muscle fatigue.

5. Lisfranc or Midfoot Injury

What Is It?

Your midfoot is made up of a small group of bones that form the arch of the foot and is known as the Lisfranc area. The midfoot also has a number of ligaments, muscles, and joints that connect the bones of the feet.

If you break a bone, dislocate a joint, or tear a tendon, it will cause pain on the top of your foot that will be worse if you stand or walk. There will be bruising on both the top and bottom of the foot.

The top of your foot will also be swollen and the pain can be so severe that you need crutches.

Cause

One of the most common causes for this type of injury is if you stumble, or twist and fall while your foot is flexed downwards.

More severe injuries to the midfoot often occur from dropping something on your foot or from a direct impact like a car crash.

Treatment

Mild injuries like a midfoot sprain can be treated at home using the RICE principle. If the ligaments aren’t torn and there are no broken bones, your doctor may recommend that you wear a cast or boot for 6 to 8 weeks.

You won’t be able to put any weight on the foot while it’s healing. Your doctor will require a follow-up appointment to make sure that the injury has healed properly and that the bones haven’t moved.

If the injury is severe, like a fractured joint in the midfoot, or if the bones have moved, then your doctor may recommend surgery to realign the joints.

Prevention

Life happens and this makes it very difficult to prevent a Lisfranc or midfoot injury. But there are steps you can take to try and prevent it from happening.

Make sure that you’re wearing the right shoes for your activity. As an example, if you’re playing soccer, you’ll need to wear the right kind of shoes to protect the most vulnerable part of your feet—the midfoot.

Runners need to make sure that they’re not running in worn-out shoes and that their midsoles provide adequate arch support, cushioning, and shock absorption.

Shoes that are a poor fit will increase your chances of tripping, losing your footing, or twisting your foot.

Work on developing your balance and proprioception—the awareness of where your limbs are in the space around you.

Having good balance and a good understanding of where your body is can help you recover your balance quickly if you do trip, as well as being lighter on your feet and reducing jarring to the joints from heavy steps.

Incorporate strength exercises into your workout routine, as this can reduce the severity of the injury.

Focus on strengthening the supporting muscles in the legs, which can increase stability and prevent accidents.

What Other Medical Conditions Can Cause Top-Of-Foot Pain?

There are a few health conditions that can cause pain on the top of the foot which is not caused by overuse injuries. Some of these conditions affect both the nerves and joints in the foot, and they are:

  • Peripheral Neuropathy
  • Bone spurs
  • Gout
  • Diabetes
  • Ganglion Cysts
  • Sinus Tarsi Syndrome
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AUTHOR

Ben is an avid road and trail runner, and has completed multiple marathons and ultras. A former running store owner, he now shares his knowledge and experience writing these articles.