Top-of-foot pain: tight laces, tendons or a stress fracture?
Short answer
Common causes of pain on top of the foot include tight shoes irritating the tendons that lift your toes (extensor tendinitis), a stress fracture from doing too much too soon, sprains, arthritis and gout. Rest, raising the foot, ice and looser, low-heeled shoes help most cases. Pain that's worse with every step, swelling over a bone, or pain after increasing your mileage needs an exam for a stress fracture.
Common causes
| Cause | Clues |
|---|---|
| Extensor tendinitis | Ache along the top of the foot; tight shoes or laces make it worse (Cleveland Clinic). |
| Stress fracture | Gradual pain worse with weight-bearing, swelling and tenderness over one spot on a bone; often after training more (AAOS). |
| Sprain or strain | After a twist or injury. |
| Arthritis or gout | Joint pain; gout comes on suddenly, red and very tender. |
Home care
The NHS recommends resting and raising the foot, ice for up to 20 minutes every 2–3 hours, comfortable low-heeled shoes, and pain relief. As a common-sense measure, loosen your laces over the sore area or skip the eyelet that presses on it.
Cleveland Clinic says extensor tendinitis takes a few weeks to a few months; AAOS says most stress fractures take 6–8 weeks to heal.
- You can't walk, the foot looks deformed, or you heard a snap (go to urgent care).
- There's swelling and pinpoint tenderness over a bone, especially after more activity (possible stress fracture).
- You have fever, redness and heat.
- Pain lasts more than 2 weeks, or you have diabetes (NHS).