How to Prevent and Treat Pain on Top of Foot

A common complaint among runners is pain on the top of the foot, right under your shoelaces. In many cases, pain on the top of the foot is due to an inflammation of the extensor tendons, which run along the top of your foot and give you the ability to straighten your toes. Inflammation of those tendons is called foot extensor tendonitis.

Symptoms of Foot Extensor Tendonitis

If you’re dealing with extensor tendonitis, you’ll feel pain on the top of your foot as you’re running. You may see swelling on the top of your foot and notice a large bump or nodule somewhere on the tendon.

A simple test to determine if pain on the top of your foot is a result of extensor tendonitis is to flex your foot downward and push down on your toes. (It’s more effective if you have someone else provide the resistance on your toes, rather than doing it yourself.) Then, try to pull your toes up against the resistance. If you feel pain across the top of your foot or along the extensor tendon, then you’re most likely dealing with extensor tendonitis.

Causes of Foot Extensor Tendonitis

The most common factors that cause extensor tendonitis are improper or too tight shoes, excessive tightness of the calf muscles, overtraining, and falling of your foot arch.

Extensor tendonitis is most often caused by lacing your shoes too tight or wearing shoes that are too small or don’t fit properly. Check your running shoes to see if they’re creating a pressure point along the top of your foot. For some runners, non-running shoes are the problem, so be sure you’re wearing comfortable shoes that fit properly when you’re not running.

Another possible cause is a change in your running habits or training. Running uphill, especially on a treadmill, can place more stress on the foot extensor tendons. To prevent overtraining and overuse injuries, be careful that you’re not increasing your overall weekly mileage by more than 10%.

How to Prevent Top of Foot Pain

Wearing the right size and type of shoes is critical so, if you’re unsure, get yourself to a running specialty store for a proper shoe fit.

Don’t tie your shoes too tight. You should be able to slide one finger under the knot. If you can’t do that, the laces are probably too tight.

Do calf stretching and self-massage with a foam roller after exercise to help prevent tight calf muscles.

How to Treat Foot Extensor Tendonitis

For mild extensor tendonitis, the most effective treatments are stretching your calf muscle and reducing the inflammation with ice or anti-inflammatories. (Talk to your health care provider to find out if you should take anti-inflammatories.)

An easy way to ice the area is to fill a bucket or small garbage pail with ice water and soak your foot for a few minutes at a time. Take it out for 30 seconds, and then re-submerge for a few more minutes. Whether you’re using an ice pack or ice water bucket method, don’t ice the area for more than 15 to 20 minutes, three or four times a day.

You can also try changing your shoe lacing pattern and loosen your laces slightly. To relieve pressure on the top of your foot, try lacing your shoes across in a ladder pattern, rather than a criss-cross pattern.

You can run through extensor tendonitis if the pain is mild and it’s not affecting your gait. If you do find running to be too painful, even after changing your lacing, take a couple of days off from running before you attempt it again.

Like many minor running injuries, extensor tendonitis often clears up after a few days of rest. Once the extensor tendon is no longer inflamed, you’ll be able to run relatively pain-free.

In some more extreme cases, a podiatrist may recommend custom-made orthotics.

What’s If It’s Not Extensor Tendonitis?

If your pain doesn’t go away after trying the above treatment, you should see a doctor and rule out another issue. Other conditions with similar symptoms include metatarsal stress fractures, atypical gout, and degenerative arthritis. Consult your podiatrist or other health care professional to determine the exact diagnosis.

More Running Foot Injuries

Running coach, avid runner, and fitness writer Christine Luff is an RRCA-certified running coach and ACE-certified personal trainer. Founder of the website Run for Good and author of the book Run for Good: How to Create a Lifelong Running Habit, she coaches runners, from beginners to advanced, who are training for races, from 5Ks to marathons.

Source: FootCareMD, American Orthopaedic Foot & Ankle Society, http://www.aofas.org