Why does the top of my foot hurt and always in pain.
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Over the past few months, I've had this persistent, dull ache right on the top of my foot, sometimes combined with a sharp pain when I bend my toes up. It makes wearing regular shoes or walking for any length of time really uncomfortable. I'm worried it might be stress fractures, but I'm not sure.
Has anyone else dealt with chronic, unexplained pain specifically on the top of the foot, and if so, what was the actual diagnosis and what solution finally worked in getting rid of the pain?
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Dr. William Naughton, DPM AdminChief Medical OfficerOfficial Account of Dr. William Naughton, DPM. As Chief Medical Officer, Dr. Naughton reviews discussions for medical safety and provides expert biomechanical insights based on 20+ years of surgical experience.Abnormal arch structure — whether high or low — is one of the most common causes of chronic pain on the top of the foot.
Altered arches increase tension on tendons, joints, and nerves across the midfoot, often leading to tendonitis, joint irritation, nerve compression, or, in some cases, stress-related bone injury.
The arch of the foot plays a critical role in distributing force during standing and walking. When the arch is excessively high or overly flat, normal load-sharing across the foot is disrupted. This altered biomechanics places increased strain on the extensor tendons and the small joints of the midfoot, particularly along the dorsal (top) surface of the foot.
One common result is extensor tendonitis, which typically presents as aching or burning pain across the top of the foot and sharp discomfort when the toes are lifted upward. In individuals with high arches, the rigid foot structure can also overload the midfoot joints, aggravating dorsal midfoot arthritis, which tends to produce deeper, joint-based pain that worsens with toe movement or prolonged standing.
Another potential contributor is nerve entrapment, most commonly involving the deep peroneal nerve. This type of irritation often causes burning, tingling, or electric-like sensations across the top of the foot. Less commonly, metatarsal stress fractures may develop, resulting in pinpoint pain that intensifies with activity and sometimes with toe extension.
Common causes of pain on the top of the foot include:
- Extensor tendonitis (tenderness along the tendon path)
- Midfoot arthritis (deeper, joint-centered pain)
- Nerve irritation (sharp, burning, or electric sensations)
- Stress fractures (localized pain that worsens with activity)
- Vascular disease
Warning signs that warrant evaluation:
- Persistent or worsening pain
- Swelling or redness
- Numbness, tingling, or nighttime pain
Addressing foot mechanics is essential. Supportive footwear and properly designed custom orthotics can help reduce abnormal strain across the foot and improve overall alignment.
