The 5 Most Common Causes of Pain On Top of The Foot While Running

running shoes

Are you experiencing top of foot pain when running?

Then you have come to the right place.

Here’s the truth. Running is a high impact sport per excellence—it can take a toll on your body, especially your feet, your first point of contact with the ground.

This foot pain is a common complaint among runners of all backgrounds and training levels.

However, unlike notorious conditions such as runners knee and plantar fasciitis, diagnosing top-of-foot pain in runners is tricky.

There are many conditions that cause pain in the region, which makes determining which one is which easier said than done.

But fret no more.

In this article, I’ll outline some of the most common causes on top of foot pain in runners as well as how to prevent foot pain so you can get the most out of your training.

Sounds great?

Let’s lace up and dig in.

Anatomy 101

The human foot is a complex set of 26 bones, 33 joints, and more than 100 muscles, ligaments, and tendons.

When you log the miles, every one of these structures fulfills a specific function, and if any is deficient, not only will you come down with discomfort or pain, you also experience alignment issues elsewhere.

The human body is, after all, one connected chain—only as strong as the weakest link.

You may feel an ache, inflammation or tenderness, burning sensation, or a sharp pain that may come and go, depending on the cause and your activity.

5 Causes OF Top Of The Foot Pain In Runners

Here are the main conditions that can cause pain on top of your foot while running:

  • Extensor Tendonitis
  • Metatarsal Stress Fracture
  • Bone Spur
  • Vamp Disease
  • Arthritis

Let’s briefly discuss each one of these, then share a few ways to prevent the top of the foot pain while running.

  1. Extensor Tendonitis

One of the most common causes of pain on the top of the foot is a condition known as extensor tendonitis.

As the name implies, extensor tendonitis is an inflammation of the extensor tendons—a set of tendons that run along the top of the foot and are in charge of pulling it upward as well as straightening the toes.

When coming down with extensor tendonitis, you’ll feel pain on top of the foot, especially in the middle between your ankle and the ball of your foot.

The main symptoms include:

  • Swelling, bruising, or redness on the top of the foot
  • Pain in the center of the foot, especially in the middle of the foot and off to the instep, near the big toe.
  • The development of a large bump somewhere along the tendon

Some of the main factors that contribute to the condition include:

  • Running too much too soon
  • Standing for long periods of time
  • Wearing improper shoes that are too tight or too small
  • Running on on uneven surfaces
  • Biomechanics deficiencies, such as fallen foot arch or tight calf muscles

How To Treat Extensor Tendonitis

The most effective way to manage mild extensor tendonitis is to soothe inflammation with rest, ice, and stretching the calf muscles. You should also perform a few grip exercises to reduce stress on the tendon, along with flexing your foot up toward the shin.

What’s more?

Consider using custom orthotics if you have a high-arch foot type as well as changing your shoe lacing pattern and loosen your laces a bit (more on this later).

Consult a doctor for serious cases.

2. Metatarsal Stress Fracture

Another common cause of top of the foot pain in runners is a stress fracture.

Logging the miles too hard or too fast can take a toll on your weight-bearing bones and, over time, lead to stress fractures. These consist of a tiny break in the bone caused by repetitive shock rather than an acute injury, such as a fall or accident.

Again, overuse is the main cause of stress fractures, but factors that can contribute to it include:

  • Bad running technique
  • Running on hard surfaces
  • Improper running shoes
  • Vitamin D deficiencies
  • And so much more.

(Check my full guide to stress fracture for more).

As I mentioned before, there are 26 bones in the foot, and any one of them can be prone to a stress fracture from running.

More specifically, the center of your foot houses five metatarsal bones, and any one of them can fall victim to a stress fracture if you run too hard too fast, too soon, especially in the second through fourth metatarsal bones.

This notorious condition starts off as mild pain and then slowly worsens over time. You may experience pain only while running, but as it progresses, you’ll also feel the pain when at rest, even when sleeping.

As the condition worsens, the pain on top of the foot will come on faster and will last longer.

Main symptoms include:

  • Pain and swelling focused on the top of the foot over the bones
  • Tenderness on top of the foot where the stress fracture is located
  • Mild to severe swelling in the affected foot.

How to Treat A Stress Fracture

If you suspect a stress fracture, consult a doctor immediately as it requires a more aggressive treatment plan. Plus, it can only be confirmed by getting an X-ray.

More than likely, you’ll need to wear a boot or some other form of device.

Once your fracture heals, it’s key to go back and assess your running habits to determine why you got hurt.

Or else, you may risk exacerbating your condition, like creating a full-on fracture or another stress fracture.

3. Bone Spur

What’s known as osteophyte, a bone spur is a bony growth formed on a normal bone. This extra growth can cause wear and tear or pain if it rubs on other tissue such as tendons, ligaments, or nerves in the body.

These usually develop when the body grows extra bone as it tries to repair damage caused by shock or pressure placed on the bone for a long period of time.

Many things can contribute to the formation of a bone spur, such as improper shoes, injury, and age.

How To Treat A Bone Spur

To treat a bone spur, consider changing your running shoes and trying an orthotic to cushion the top of your foot and see if it helps relieve symptoms. As a rule, run in proper shoes—a pair that’s not too tight or too loose and that fits well with your foot type and running style.

Unless they’re causing serious pain, usually bone spurs don’t call for aggressive treatment.

Measures that can help manage bone spurts include weight loss to reduce some of the pressures on the joints. This is especially the case if plantar fasciitis or osteoarthritis is the cause. Stretching the affected limb can also help with pain relief and healing.

For starters, try alternating between cold and heat therapy to ease the pain associated with a bone spur. Ice works very well for soothing swelling and inflammation, while the heat can improve pain and stiffness.

In some cases, you might need cortisone injected administered by your doctor, which helps limit inflammation.

4. Vamp Disease

Vamp disease refers to irritation over the top of the foot that often occurs when you tie up your running shoes too tightly. It’s more specifically an inflammatory swelling on the top aspect of the foot corresponding to the vamp of the shoe—hence the name.

How to Treat Vamp Disease

Easy. Choose well-fitting running shoes and replace them as they wear out. You should also try out different lacing techniques and see which one works the best for you.

As a rule, loosen up your laces or switch to sneakers that fit better so you don’t have to cinch up so tightly.

You should have enough to be able to put your finger under the top laces—or else, you might be lacing your shoes too tightly.

If your symptoms don’t fade away after changing up your shoes, your pain could be caused by something else.

Expect the pain to fade within two to three weeks as the inflammation subsides.

5. Arthritis

Arthritis refers to the deterioration of the cartilage that cushions the bones in your joints, and it’s a common source of pain on the top of the foot.

There are 30 joints in the foot—any of these joints can fall victim to arthritis, hence, lead to pain on the top of the foot.

Midfoot arthritis manifests as pain and swelling in the midfoot and is made worst by high-impact exercises such as running.

According to my research, the most prone spot on top of the foot is the area situated at the base of each toe in the metatarsophalangeal joints. (See Image).

Typically, the symptoms develop slowly over time, but it can also be the result of a major midfoot injury, such as a Lisfranc injury.

Symptoms include:

  • Tenderness pain in the injured area
  • Loss of flexibility in the affected foot.

How to Treat Arthritis

Book a doctor visit if you’re coming down with any of the above symptoms that refuse to fade away with rest and ice. A physician can help you determine the right treatment plan that will work best for you.

Don’t try to heal arthritis on your own—you might end up making things worse, and you don’t want that.

Depending on the the type and severity of your arthritis, your doctor may recommend any of these treatment options:

  • Steroid medications injected into your joints
  • Anti-inflammatory drugs to soothe swelling
  • Pain relievers
  • Pads or arch supports in your running shoes
  • Canes or braces for added support
  • Physical therapy
  • Custom-fitted shoes

How To Prevent Top of The Foot Pain When Running

Here are five measures that should work the best for keeping your top-of-the-foot pain at bay while running.

Proper Running Shoes

I hate to sound like a broken record, but wearing improper running shoes can cause all sorts of pains—foot pain is not an exception.

First, examine your shoes right now and see if:

  • Your shoes are too small
  • Your shoes are too tight
  • You have been tying your shoes too tightly

If any of these apply, you’re setting yourself for foot pain.

Shoes too tight? Time to get a new pair.

Head to the nearest, especially running store and ask the staff there for advice.

They should be able to match you up with the right pair according to your size, foot shape, and level of support you need.

This is especially the case if you have any foot anatomical challenges and/or a history of foot pain.

Replace Your Shoes

As in good things in life, running shoes also have a lifespan—try to run in past their prime, and you’ll be setting yourself for misery.

As a guideline, replace your running shoes every 400 to 500 miles. For example, if you run 30 miles a week, you should be looking for a new pair every four to five months.

Lace Properly

Another measure to help you prevent pain on the top of the foot while running is to check your lacing technique.

For example, experiment with tying your laces at the side or miss the eyeholes over the affected area.

But all in all, the best tying method for soothing pressure on top of the foot is the two-laced technique.

This YouTube tutorial shows you how:

Consider Orthotics

If you overpronate and/or have a history of injuries in the lower leg, consider using supportive inserts or custom-made orthotics. Consult with a physical therapist or podiatrist to help you with options.

When to See A Doctor For Runners Foot Pain

If symptoms don’t fade away despite the above options, it’s time to get professional help.

You might be dealing with a different condition or injury and need more help.

Even relatively foot pain while running can be quite debilitating.  For chronic pain that refers to fade away with simple home remedies, you should seek medical treatment.

Especially if you’ve:

  • Pain persists for more than a week
  • Stubborn numbness in the foot
  • Signs of infection, such as warmth, redness, and tenderness in the affected limb.
  • Complete inability to walk or weight bears on the foot.

A doctor will help you rule out the cause of your pain and determine the seriousness of your conditions. From there, they can examine your situation and recommend the right course of treatment and prevention. The rest is just details.

Foot pain can progress to more severe foot issues and may leave cause damage in your lower legs, knees, even your back.

Conclusion

There you have it. If you’re experiencing top-of-the-foot pain while running, then today’s post most likely has the solution to what’s ailing you.

If not, then you should consult a doctor as soon as possible to rule out any other conditions that might be the culprit behind your pain. The rest is just details.

Please feel free to leave your comments and questions in the section below.

In the meantime, thank you for dropping by.

Keep training strong.

David.