From the heel to the instep, the pain can occur anywhere in the foot. But when the outside of the foot hurts, it can be especially excruciating. Lateral foot pain, which runs along the outer edge of the foot and ankle, can make even the simplest movements (such as standing and walking) challenging.
The instep is one of the parts of the body that supports all our weight throughout the day, so it is not surprising that foot pain is relatively common.
Pain on the top of the foot can be caused by a number of different conditions, the most common of which are due to overuse in activities such as running, jumping, or kicking.
If your top foot pain is usually worse in the morning and improves with movement throughout the day, you may have arthritis, a degenerative joint disease. More specifically, arthritis in the ankle joint could be causing pain on the side of the foot.
When the pain is on the lateral side of the ankle, it usually implies post-traumatic arthritis or joint disease that occurs after an injury to the ankle or ankle ligaments. Instep pain could also be caused by arthritis of the subtalar joint. It is possible to develop arthritis in the subtalar joint (the joint just below the ankle joint) if there is an associated flatfoot deformity. This is because a severe flatfoot demonstrates abnormal angulation of the heel bone, which can lead to lateral impingement of the subtalar joint.
A stress fracture, or small crack, in the fifth metatarsal bone (the long bone just below the little toe) can cause instep pain. Unlike arthritic pain, foot pain from a stress fracture is usually a slow-onset pain that worsens throughout the day.
This is common in people who are on their feet for long periods of time or who do high-impact exercises that involve jumping or running. It is also more common in high-arched feet.
Instep pain could be related to peroneal tendinitis, that is, inflammation in the peroneal tendon. This tendon runs from the outside of the leg to a bone in the bottom of the foot, and pain can occur anywhere along the tendon. However, the pain most often occurs behind the outer ankle bone and the outside of the foot.
Peroneal tendinitis tends to develop in runners, especially those who don’t change their shoes often enough or increase their mileage or pace too quickly.
Bursitis could be the source of the instep pain. This occurs when a bursa, a sac of fluid located around bony prominences (ie, areas where bones are close to the surface of the skin), becomes inflamed. Bursitis can occur on the top of the foot, around the base of the little toe.
Some people can form an inflamed bursa in this area due to uncomfortable shoes rubbing against the foot and irritating the bony prominence.
If the instep pain is accompanied by tingling or numbness, we may have a pinched nerve. Compression of the sural nerve, which runs down the outside of the leg to the toes, can cause lateral foot pain, tingling, or even temporary numbness in the lateral leg and foot, which It is called neuropraxia. Sural nerve compression could be from a direct injury or from wearing a cast if the cast is tight around the calf area.
Additionally, pinched nerves in the back from herniated discs (specifically involving L5) can also cause pain on the top of the foot. In this case, the pain usually starts in the lower back and radiates down the lower leg.
Sometimes, it’s just a simple ankle sprain that starts the instep pain. Most of the time, the injury causes pain on the top of the foot because the ankle is twisted inward and the ligaments are sprained.
In many cases, ankle sprains involve the anterior talofibular ligament, the shortest (and most commonly injured) lateral ligament. Recurrent lateral ankle sprains can cause chronic ankle instability, which can affect balance.
A problem with the cuboid, a small bone on the outside of the foot, could be causing pain in the toes. Cuboid syndrome is the partial dislocation of the cuboid bone in the foot, which is caused by injury to the surrounding ligaments. When there is a tear in these ligaments, the cuboid can move upward, causing pain on the outside of the foot.
This is a difficult condition to diagnose and is often misdiagnosed as a sprained ankle or peroneal tendinitis.
Although most bunions are located next to the big toe, a tailor’s bunion, also known as a bunion, can develop on the outside of the foot and cause pain. This happens when a person has a genetic deformity in the foot, which causes a bunion to form near the ball of the foot.
Tailor’s bunion pain ranges from chronic pain to acute pain, and there is often swelling and redness in the area as well.
If the instep pain is persistent and lasts for more than a week despite treatment in each, a visit to the doctor should be made. We should also call the doctor if the pain is severe enough to prevent us from walking, or if we have burning, numbness or tingling in the affected foot.
The doctor will ask about any other symptoms and possible ways the foot could have been injured. We may be asked about physical activity and any previous foot or ankle injuries. Next, the doctor will examine the foot. They may press on different areas of your foot to see where you feel pain. They may also ask us to walk and do exercises like rolling the foot to assess range of motion.
To test for extensor tendinitis, the doctor will ask you to flex your foot downward and then try to lift your toes while resisting. If we feel pain, it is likely that the cause is extensor tendinitis. If your doctor suspects a broken bone, fracture, or bone spur, he or she will order an X-ray of your foot.
Since our feet support our entire body weight, a minor injury could turn into a more extensive one if left untreated. Seek immediate treatment if we suspect an injury is significant. Most causes of top foot pain are highly treatable, but should be treated before the pain and injury worsen.
- Arthritis . Ankle and subtalar arthritis may be treated with anti-inflammatory drugs (NSAIDs), bandaging, and occasionally localized steroid injections. Orthotics can also offer relief. Custom orthoses help maintain optimal heel bone position and thus impact subtalar and ankle alignment. The amount of arch support and correction in orthoses is determined by a podiatrist using X-ray images and gait analysis.
- stress fractures . To treat stress fractures, it is important to modify activity during bone healing, which is six to eight weeks. It is advised to keep the foot immobilized in a CAM (controlled ankle movement) walker or walking boot for about three weeks. Additionally, custom braces with a specific modification called the distal metatarsal pad might be helpful in preventing the stress fracture from reoccurring. The metatarsal pad offloads the metatarsal bone to dissipate pressure from the metatarsal head and metatarsal neck.
- Tendinitis . A period of rest, icing, compression and elevation for one week is advised. Afterward we may also want to wear a brace or use kinesiology tape for continued support. Once the swelling goes down (usually two weeks), it is important to stretch and strengthen the tendon again. Instep strengthening can be done at home with exercises involving a theraband (for resistance) or in physical therapy if pain continues.
- bursitis . Bursitis is treated by removing the irritant that is causing the bursa to form. For example, the solution may be as simple as changing your shoes. Occasionally, the bursa can be made smaller and painless with a localized steroid injection and padding around the bursa. NSAIDs might also help with pain and inflammation.
- Pinched nerves . Sural nerve compression should resolve on its own over time. Laser therapy, a form of high-powered light therapy, can help nerve compression resolve faster. If lateral foot pain originates from pinched nerves in the back, they should be treated locally as that is the area where nerve signal is compromised.
- sprain . If we have a sprain, we will apply rest, ice, compression and elevation within the first 48 hours of the injury. This should significantly reduce symptoms of discomfort. If the pain continues, there may be a larger tear or injury.
- cuboid syndrome . Depending on the severity of the injury, treatment may include a period of immobilization in a walking boot. In more severe cases, it may be necessary to put the cuboid back in place under local anesthesia.
- Bunion . Conservative treatment involves shoe modification (specifically, changing to wider shoes), topical and oral anti-inflammatory medications, physical therapy, and localized steroid injections. When conservative treatment fails, surgical correction of the bunion should be considered, which involves cutting the bone and moving it into the proper position.