Pain on the top of the foot is quite common and can occur for a variety of reasons. One of the more common groups of structures to be affected are the extensor tendons that operate the toes. They are indicated in the adjacent diagram. Often, foot pronation (rolling in, being flat footed) is a big part of the problem. When the foot collapses with excessive pronation, the big muscles of the inner leg (tibialis anterior and tibialis posterior) work hard to pull the arch up or, a least, slow down the speed of the drop towards the ground. When they get tired, they recruit the muscles of the top of the foot to help them. As you can appreciate from the diagram, these muscles are small and the job quickly becomes too much for them. They become painful from what is termed an ‘overuse injury’. Therefore, this condition is not one that responds to strengthening exercises but rather to a ‘rest’. In this case, the rest does not mean you have to take to the couch, but rather the foot function needs to be addressed. By restoring the foot function back to normal and stopping the excessive pronation with an orthotic, the muscles can return to only doing the job they were meant to do. This is almost always enough ‘rest’ to relieve the pain.
Another kind of top of the foot pain involving numbness in the toes is discussed in FAQ 103.
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