What Causes Foot Pain on the Top of the Foot?

I see a lot of patients at our clinic who come in confused, frustrated, or even worried about pain on the top of their feet. And truth be told, I’ve dealt with it myself. Foot pain can make even simple daily activities feel difficult, especially if you’re active or a runner like me.

Let’s chat about why it happens, what you can do about it, and when you might need a little extra help from a professional (like me!).

Is your shoe causing your foot pain?

The first thing I always ask anyone who experiences foot pain is, “How do your shoes fit?” Shoes that are too tight or even too loose can put unexpected pressure on the top of your foot. This often irritates the tendons and tissues, causing inflammation and discomfort.

I’ve noticed that many people lace their shoes too tightly without even realising it. A simple change in your shoe lacing technique—like parallel or “ladder” lacing—can significantly reduce the pressure on the top of your foot. I’ve personally found this helpful for both myself and my patients.

You might want to check out this helpful guide which explains more about proper footwear choices.

Inflamed tendons could be your problem

If shoes aren’t the issue, then you might be dealing with something called extensor tendonitis. These tendons run along the top of your foot and help lift your toes. When they’re overworked—say, from running or hiking—they can become inflamed and cause sharp, burning pain.

I see this a lot in runners. If you’ve recently increased your training intensity or changed your running style, you might have irritated these tendons. If this sounds like you, our running assessment service could pinpoint exactly what’s going wrong.

Here’s another great article with some more in-depth information on extensor tendonitis.

Could it be a stress fracture?

Now, if changing shoes and rest aren’t doing the trick, I usually start worrying about a stress fracture. This is more serious. It occurs when small cracks develop in your foot bones from repeated stress—like pounding pavements during long runs or playing sports without proper rest.

I saw someone recently who kept ignoring their foot pain, thinking it would just go away. By the time they came in, their simple injury had become a full-blown stress fracture. It’s never worth waiting it out, especially if your pain doesn’t improve with basic rest and care.

If this is ringing alarm bells, definitely check out our page on stress fractures to see if your symptoms match up.

Nerve problems might surprise you

Not many people realise this, but nerve issues can also cause pain on the top of your foot. A condition called Morton’s neuroma affects nerves between your toes and can radiate pain upwards, tricking you into thinking it’s coming from the top of your foot.

To clear up confusion, I often recommend getting a gait analysis. This can show if there’s unusual pressure or nerve irritation as you move. It’s amazing how much you can learn just by seeing how someone walks or runs.

Arthritis isn’t just for knees

Another common yet overlooked culprit is arthritis. While people typically associate arthritis with knees or hips, it can absolutely affect your feet. Pain, stiffness, and swelling at the top of the foot could signal arthritis, especially if you’re over 40 or have previous foot injuries.

Arthritis-related foot pain can benefit greatly from therapies like our radial shockwave therapy or even custom orthotics. These treatments have helped many of my patients reduce pain and stay active.

Practical steps you can take right now

Besides professional help, there are immediate steps you can take at home:

1. Ice your foot regularly if it’s inflamed or swollen.
2. Take short breaks from intense activities.
3. Use anti-inflammatory medications (after consulting with your GP).
4. Adjust your lacing technique or try new footwear.

But if your pain persists or keeps coming back, it’s probably time to get it checked out.

At Up & Running Podiatry, we’re pretty passionate about keeping you moving comfortably. Whether you’re a runner, an athlete, or someone who simply enjoys being active, we have a range of options available to help. Visit our booking page and let’s get to the bottom of your foot pain together.

If you’re curious about how well your feet are functioning, you might also find our functional testing particularly insightful.

Don’t ignore that nagging pain. Trust me, your feet will thank you.