top of foot pain both feet

by William
(Saugus, Mass. 01906)

started about i month ago, left foot in am had top of foot pain. Since then it has moved to both feet. Had yearly physical 3 months ago including blood work up. Blood sugar was fine and BP was ok. Recently had steroid epidural in lower back. Was taking 800 mg motrin for two weeks. Have stopped that now my feet are getting worse.

RESPONSE

Hi William,

For starters since the pain is now occurring in both feet I do not suspect a fracture as the liklihood of having a broken bone, such as a stress fracture in both feet in the same area is extremely low (though not impossible).
So that leaves us with two main possibilities. The first would be tendonitis which is an inflammation of the tendons that run down from the ankle, over the top of your feet and basically control the movement of the toes.
If the tendons are involved, then forcefully moving your toes up and down will cause pain. The top of the foot might also be partially swollen.
Tendonitis can occur for no apparent reason, there does not have to be a history of trauma. Sometimes a certain activity, like climbing up and down a lot of stairs might set it off. Other times the shoes that you wear may also set it off particularly if the shoes are very flexible and thus cause a lot of motion in the foot.
Tendonitis is generally self limiting. This means it will get better on its own, assuming you eliminate the activity or the shoe that is causing the problem. Foot problems do take longer to heal than other body parts simply because every time you walk, you are basically re-injuring an already injured area, so that does slow down the process.
The next most common condition that will cause pain on the top of the foot and could easily be occurring in both feet, is what is known as a midtarsal fault.
In people that have a tendency to excessively flatten out their feet when they walk, over time, the highest part of the arch begins to collapse from the flattening. Where the arch begins to collapse, two bones end up jamming into each other and eventually cause an arthritic degeneration in that area. This will cause pain due to the arthritis that is formed.
This is a diagnosis that usually only a foot specialist will be able to make because it is not a well known condition amongst non foot specialists.
The simplest way to treat this is with the use of an orthotic, or arch support which now prevents the foot from collapsing and thus diminishes the jamming effect of the two bones at the top of the arch.
The fact that the Motrin you were taking seemed to help your foot pain, does not give me any indication as to which condition you may be suffering from, as Motrin would probably be helpful with both issues.
If this problem lasts beyond lets say two weeks without resolving itself, or the pain is getting progressively worse, then I would suggest you se a foot specialist in your area.

Marc Mitnick DPM
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