Arthritis Treatment: How to Treat Pain in the Top of the Foot

Foot pain is ubiquitous in society since most people get around by walking.

The foot consists of 26 bones which are held together with a complex arrangement of ligaments, muscles, and tendons.

In addition, multiple nerves and blood vessels traverse the foot.

While much attention is placed on disorders of the arch of the foot and the heel, the top of the foot is often the site of discomfort.

The reason this area is susceptible to pain is because of the anatomy. In addition to being an area where many of the small bones of the foot interact, it is also a location where many of the critical nerves and blood vessels traverse.

The most common cause of pain in the top of the foot is osteoarthritis. Osteoarthritis is a disorder due to derangement in cartilage metabolism. Cartilage is the gristle that provides the cushioning between bones.

It consists of a matrix made up of collagen and proteoglycans. Proteoglycans are complexes of proteins and sugars. Within this matrix are cells called chondrocytes which help manufacture and nourish the matrix. When a trigger such as trauma occurs, there is a change in the complexion of cartilage. The chondrocytes begin to make destructive enzymes and the cartilage begins to wear away. The underlying bone starts to react by forming bony spurs. These spurs, particularly in the top of the foot, impinge upon nerves and blood vessels. The spurs also rub against each other leading to pain.

Anything that magnifies this problem will also magnify the pain. For example, wearing shoes that compress the top of the foot can make pain in the top of the foot worse. The treatment here is, at least early on, to reduce the amount of pressure, use anti-inflammatory medicines either by mouth or topically, and possibly injections of glucocorticoid. Since this is an area where the joints are narrow and many blood vessels and nerves are located, it is best to use ultrasound guidance for injections.

Since some spurs will continue to irritate nerves, sometimes the best treatment is to remove the spurs using a technique called tenotomy where a sharpened needle bevel is used to "chisel" the spurs, and then platelet-rich plasma (PRP) is used to heal the area. In our hands, this technique, again using ultrasound guidance, has been very successful.

Another cause of pain in the top of the foot is gout. Gout is a metabolic disease due to the excessive accumulation of monosodium urate crystals. The treatment is to reduce the uric acid load in the body. This is best accomplished with a combination of dietary as medicine therapies.

Tendonitis can also occur in the top of the foot. This is sometimes seen in people who have walked or run a long distance wearing tight shoes or other footwear that irritates the top of the foot.