Pain on the bridge of my foot

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Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Pain on top of the foot is a common problem. Every step we take places a force 1.5x body weight through our feet so it's no wonder our feet get sore!

Most cases of pain on top of the foot are due to either an injury, overuse, wear and tear or even ill-fitting footwear. Pain may be due to a problem in the bones, soft tissues or various medical conditions. There may even be a top of foot lump.

We are going to look at the common causes of pain on top of the foot, how they present and the best ways to treat them. 

Common Causes Of Top Of Foot Pain

The most common causes of pain in the top of the foot are due to damage to the:

• Bones: e.g. stress fractures, sinus tarsi syndrome, toe deformities & tarsal coalition
• Soft Tissues: e.g. extensor tendonitis or tibialis anterior tendonitis
• Skin: e.g.athlete's foot 
• Medical Conditions: e.g. gout, ganglions or nerve damage

1. Stress Fractures

A stress fracture is a common cause of pain on top of the foot caused by a small break in one of the foot bones e.g. metatarsal fracture

Stress fractures cause moderate to severe pain, swelling and tenderness over the fracture site.

Most stress fractures are the result of repetitive overloading e.g. kicking, running, jumping or suddenly increasing training levels.

You can find out all about the different causes, symptoms and treatment options in the Foot Stress Fractures section.

2. Sinus Tarsi Syndrome

Sinus tarsi syndrome is a common cause of ongoing pain on top of foot after an ankle sprain. With sinus tarsi syndrome there is inflammation of the small, bony channel between the heel & ankle.

Common symptoms include ankle stiffness, instability, pain on outer side of the top of the foot when walking or standing.

Sinus tarsi syndrome most often develops after an ankle sprain but may also be due to prolonged instability and altered foot biomechanics

Find out all about the common causes, symptoms, diagnosis and treatment options in the Sinus Tarsi Syndrome section.

3. Hammer, Claw & Mallet Toe

There are three common toe deformities that cause top of foot pain by altering the positions of the small bones

The most common symptoms of these toe deformities are abnormal curling of one or more toe which may or may not be accompanied by stiffness and pain.

Toe deformities often develop from wearing tight, pointed shoes but may also be caused by a toe injury, problems in nerves or blood vessels or arthritis

Find out all about these common toe deformities, how to tell which one you have and how to treatment them Hammer, Mallet, Claw Toes section.

4. Extensor Tendonitis

Extensor tendonitis is one of the most common causes of gradual onset pain on top of foot. With extensor tendonitis there is inflammation of the tendons on the top of the foot that contract to lift the toes.

Extensor tendonitis usually causes a gradual increase in pain, swelling & tenderness over top of foot and there is often discomfort when wearing shoes due to pressure on the tendons

Tight shoes, flat feet, prolonged standing/walking, muscle tightness and off-road running are common causes of extensor tendonitis.

You can find out all about this common cause of pain on top of foot, including the causes, symptoms and treatment options in the Extensor Tendonitis section.

5. Tibialis Anterior Tendonitis

Another possible cause of top of foot pain is tibilais anterior tendonitis. This is where there is inflammation of the tendon at the front of the ankle that lifts up the foot.

Tibialis anterior tendonitis usually causes a gradual increase in pain on top of foot and at the front of ankle which often feels worse after resting.

Common causes incude overuse e.g. running, esp. off-road or downhill and muscle weakness & tightness.

You can find out all about the common causes, symptoms and treatment options in the Foot Tendonitis section.

6. Gout Foot

Gout is a type of inflammatory arthritis that causes crystals formation in joints e.g. big toe, due to high uric acid levels.

Gout foot causes a sudden onset of intense pain in the big toe and on top of the foot (typically at night), redness, heat and swelling in the foot.

You are more at risk of developing foot gout if you have a purine-rich diet (lots of red meat), have a family history of gout, are overweight or have diabetes. 

Find out all about the causes and symptoms of gout and how to treat and prevent it in the Gout Foot section.

7. Athlete's Foot

One of the less common causes of pain on top of the foot is Athletes Foot, a fungal infection of the skin. Also known as tinea pedis it affects approximately 15% of the world's population.

Athlete's foot results in scaly, itchy, flaking skin, swelling and blistering which can cause pain on top of the foot.

It normally develops due to poor foot hygiene, excess moisture, humid conditions and is highly contagious.

You can find out all about the causes, symptoms and treatment options in the Foot Rashes section.

8. Nerve Pain

Pain on top of the foot that is accompanied by altered sensation is often due to pinching or compression of nerve in the foot, leg or lower back.

There may burning or shooting pain along the top of the foot, pins and needles, numbness and/or foot weakness

Nerve injuries usually originate from swelling, injury, spinal deformity or disc bulge in the lower back. There is often no actual pain in the back itself, the symptoms may only be felt in the foot.

Find out all about the causes, symptoms, diagnosis and treatment options in the Nerve Pain In Foot section.

9. Ganglion Cyst

Pain on top of the foot that is accompanied by a lump is often due to a ganglion.

Ganglion cysts are small lumps filled with jelly-like fluid often found near the foot joints & tendons.

They are small, pea-like nodules that can causes pain if the press on nearby structures in the foot, particularly nerves.

Often there is no obvious reason why ganglion cysts develop but they are more common after a foot injury or as we age.

10. Tarsal Coalition

Tarsal coalition is a rare cause of pain on top of the foot affecting only around 1% of the population.

With tarsal coalition, a bony bridge forms between two or more of the foot bones. This leads to stiffness, instability and foot pain, typically in early adolescence.

Tarsal coalition is a congenital condition (present since birth) and is often hereditary.

Find out all about the common causes, symptoms and treatment options in the Tarsal Coalition section.

You can find out loads more about each of these conditions, including the best treatment options for each one, by using the links above.

Diagnosing Pain On Top Of Foot

Much of the time, pain on top of the foot will settle down, using simple home treatments, within a week. If the pain persists for longer, or is severe, you should see your doctor. 

The doctor will ask you:

• when your top of foot pain started
• how it started
• if you have any other symptoms
• about any past foot or ankle injuries
• your normal activity levels
• what things make the pain better or worse
• if there is any pattern to your pain

Then, they will examine your foot for any signs of swelling or deformity. The will look at you walking and then look at the movement and strength in and around your foot.

If the doctor suspects a bony injury, you will be sent for an x-ray. They may also order blood tests or an MRI.

What's Causing My Top Of Foot Pain?

Pain on top of the foot is often accompanied by other symptoms which can help you to work out what is causing your top of foot pain:

• Mild-Moderate Pain On Top Of Foot (Gradual Onset): extensor tendonitis (top of foot), tibialis anterior tendonitis (front of ankle)
  
• Stiffness and Instability: sinus tarsi syndrome (after ankle sprain), tarsal coalition (early adolescence)
  
• Severe, Sudden Pain: stress fracture (day), gout (night)
  
• Top Worse after Rest: tendonitis
  
• Worse with Activity: stress fracture, sinus tarsi syndrome, tendonitis
  
• Abnormal Toe Curling: hammer, mallet or claw toe
  
• Redness Big Toe: gout
  
• Lump On Top Of Foot: ganglion, stress fracture
  
• Itchy, Flaking Skin: athlete's foot
  
• Pins and Needles or Numbness: nerve problem

Treating Pain On Top Of Foot

Treatment for pain on top of the foot will depend on what the underlying cause is. If it is a minor problem with minimal pain and swelling, you can usually treat your top of foot pain at home with a combination of:

• Rest
• Ice
• Anti-inflammatories
• Elevation
• Compression Bandage (Tubigrip)
• Gentle exercises
• Reducing your activity levels

If the foot pain is more severe, is getting worse, there is a lump on top of foot, significant swelling or you are unable to bear weight, you should see you doctor. They may then advise:

• physical therapy
• orthotics
• acupuncture
• crutches
• surgery (rare)

You can find out loads more about how to reduce pain on top of the foot in the foot pain treatment section.

What Else Can Help?

Here, we have looked at the ten most common causes of pain on top of foot. Any new incidence of pain should always be assessed by your doctor to ensure an accurate diagnosis. 

To find out more about these common causes of pain on top of foot, choose the appropriate link above. Or, if you want some help working out what is causing your top of foot pain, visit the foot pain diagnosis section.

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Page Last Updated: 09/14/22
Next Review Due: 09/14/24

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