Arthritis Treatment: Pain in the Top of the Foot and Its Causes

The anatomy of the foot is complex. And this complexity is also responsible for the eventual development of pain. The action of taking a step is a stereotypical process. The first is heel strike, then foot flat to the surface, then mid-stance, followed by heel lift and finally toe off. Any disturbance in this sequence will lead to mechanical dysfunction and pain.

The foot consists of 22 bones each "coated" with a layer of cartilage so that each interacts with the others in true joint fashion. The foot is divided into three sections: the forefoot (ball of the foot and toes), the mid-foot, and finally the hind foot which actually is part of the ankle.

This entire complex is supported by numerous ligaments and muscles.

In evaluating the motion of the foot, it is evident that it can point up or down, side to side, and also roll in (pronate) or roll out (supinate.) Taking into consideration it has to do all that while bearing weight makes it easy to understand why arthritic problems are so common.

So what conditions can cause pain in the foot, particularly the top of the foot? The most common is osteoarthritis developing in the mid-foot.

Osteoarthritis is a disease characterized by abnormal cartilage metabolism that eventuates in cartilage loss, inflammation of the joint, and the development of bony spurs. Typically, a patient will complain of pain in the top of the foot. They won't be able to wear shoes that put pressure on the top of the foot. On examination, bony spurs can be palpated. There may be signs of local inflammation.

Conservative management consists of the application of topical non-steroidal anti-inflammatory preparations and avoidance of footwear that puts pressure on the affected area. While injections of glucocorticoid ('cortisone") may provide temporary relief, in general, the results are not satisfactory.

Recently, the needle tenotomy using ultrasound guidance to remove the spurs, followed by injection of platelet-rich plasma has appeared to be effective for a number of patients. Surgery is usually not recommended.

Gout is another form of arthritis that affects the top of the foot. Here, local steroid injection followed by anti-inflammatory medicines or colchicine to break the acute attack and uric-acid lowering therapies to treat the chronic condition is advised.

Pseudogout can also affect the foot and must be differentiated from gout because the treatment is different.

Rheumatoid arthritis is a common cause of pain in the top of the foot. The treatment here is local steroid injection and systemic control of the disease.

Bursitis and tendonitis can also cause pain in the top of the foot. The treatment hinges on an accurate diagnosis. While most of these problems will respond to local glucocorticoid injection, physical therapy, and rest, some require the use of needle tenotomy and platelet-rich plasma.