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Top of Foot PainPain on the top of the foot can be caused by several different injuries or conditions:

Metatarsal Stress Fracture

A metatarsal fracture is a crack or break in one of the five metatarsal bones found in the foot. A stress fracture in a metatarsal bone usually results from applying more stress to the bone than it can hadle over any given period of time. They usually come on gradually. Any suspected metatarsal fracture warrants an evaluation by a foot fracture specialist, even if initial treatment has been started in the emergency room.  

Ganglion Cysts in the Foot and Ankle

Ganglion Cysts - A Painful Bump On the Top of The Foot.


What is a ganglion cyst?

A ganglion cyst is fluid filled sack that appears a lump or bump under the skin. In the foot this most often occurs on the top of the foot or at the big toe joint. The fluid within a ganglion cyst is actually synovial fluid (the fluid that lubricates your joints). The ganglion itself is a little balloon of synovial tissue that has squeezed out of the joint capsule. Because of this, a ganglion cysts is always a little mass attached to or extending from a joint or tendon sheath. 

Traumatic Fracture of the Metatarsal
Traumatic fractures (also known as acute fractures) are caused by the sudden application of force or trauma. This can be an impact such as a direct blow—like forcefully stubbing your toe. A metatarsal fracture is a crack or break in one of the five metatarsal bones across the top of the foot and ball of the foot.  When evaluating traumatic fractures it is important for your doctor to determine whether the broken bone is displaced or nondisplaced. In displaced fractures, the bone is not only broken, but it is also moved out of alignment. In this case, it is said to be dislocated. Treatment of these types of fractures depends on the extent of injury, the amount of displacement, and whether or not the joint surface is involved.  Surgery is sometimes required to put the bone back into proper position and stabilize it so it can heal.  
Lisfrancs Fractures
Lisfranc's Foot Fractures in the Foot: An Injury That Gets Missed Often and Won’t Get Better Without Treatment - By San Francisco’s Foot Fracture Specialist
What is a Lisfranc's Injury?
A Lisfranc’s Fracture is an injury to the midfoot where the Lisfranc’s ligament tears (called a ligament rupture by podiatrists or foot doctors). In some cases, the ligament doesn’t really tear but it yanks off a small piece of bone where the ligament is anchored. In this case doctors call it an “avulsion fracture.” Because Lisfranc’s ligament is one of the primary structures stabilizing the bones in the midfoot, a Lisfranc’s fracture has to be treated correctly to heal correctly. Otherwise continued foot pain, arthritis and loss of foot function may result.
Lisfrancs Fracture explained by San Francisco Foot Surgeon

Lisfrancs fractures involve the rupture or tearing of a of ligament that stabilizes the midfoot. Sometimes it also includes fractures of the metatarsal bones in the foot. This injury alters the alignment bases of the metatarsal bones and the cuneiform bones. These injuries are very difficult to recognize on xray, and are very frequently missed. In fact, one study (for which Dr. Segler won an award from the American College of Foot and Ankle Surgeons) showed that 98.6% of the x-ray findings suggested of these injuries were missed by board certified Emergency Room Physicians. Unfortunately, these are often debilitating injuries if not properly treated. All fractures of the mid-foot warrant an evaluation by a foot fracture specialist, even if initial treatment has been started in the emergency room.  

Midfoot Sprain

Often times I will see a patient who has midfoot pain that just won't go away.  They typically have had some sort of mnidfoot injury. Maybe a car wreck, mountain bike crash, or even stepped in a pot hole while running. Or maybey they just dropped something heavy right on top of the foot.

Extensor Tenonitis

The extensor tendons are a group of tendons on the top of the foot.  They start up in the front of the leg (in the anterior anatomic compartment) and pass down the leg along the shin, in front of the ankle, and across the top of the foot at they head out into the toes.  They lie just under the skin on the top (dorsal surface) of the foot. There job in life is to pull the toes up away from the ground (a motion called dorsiflexion by doctors). 


Neuritis is pain resulting from irritation of a nerve. On the top of the foot, neuritis is usually caused by mechanical irritation. Sometimes this can be from shoe laces tied too tight. This happens frequently to marathon runners.  Cycling shoes with the straps pulled too snug can also cause pain in the midfoot. It is usually the intermediate dorsal cutaneous nerve or deep peroneal nerve that gets compressed between the shoe on top and the hard midfoot bones underneath. Icing and anti-inflammatories can help calm it down, but above all else, you need to make sure you stop the irritation to the nerve.


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Where Does It Hurt?

 Click in the  painful area to find out what is causing your foot pain.

Big Toe Joint Pain, Bunion

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Lateral Ankle Pain

Side of foot hurts at the fifth toe base.

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