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  • Writer's picturePasadena Orthopedics, Inc.

"Top of Foot" Pain

Updated: Feb 12, 2022



The most common causes of pain on top of the feet are:

  • Dorsal compression syndrome (pressure between the joints on top of the foot)

  • Arthritis

  • Stress fracture

  • Nerve entrapment or irritation

Common symptoms of pain on top of the foot include:

  • Aching of the top of the foot without swelling (indicates dorsal compression syndrome or arthritis)

  • Swelling and pain on your forefoot (indicates a possible stress fracture)

  • Swelling and discomfort (may indicate arthritis)

  • Tingling that extends towards your toes (may indicate nerve irritation)

Since these conditions often require different therapies, the best way to ensure your top of foot pain is properly treated is to first obtain an accurate diagnosis. If the top of your foot hurts, call Dr. Sara Shirazi at Pasadena Orthopedics Inc for an immediate appointment. On your first visit, we will diagnose your top of foot problems through a review of your medical history, a physical exam of your foot and, if required, we will take x-rays. We can usually relieve your pain using conservative methods. Surgery is almost never necessary and a last resort treatment for Dr. Shirazi.


If you are not in the Pasadena or Los Angeles area and wish to try home treatment first, our recommended home therapy options are as follows:


Dorsal Compression Syndrome

This is a common cause of top of foot pain and occurs when the foot flattens out too much. The foot is an arch. When an arch collapses, the arch gets longer on the bottom and shorter on the top. So, as the foot flattens, the arch gets shorter on the top of the foot which causes pressure between the bones and pain on the top of your foot.

To treat dorsal compression syndrome, we must reduce pressure between the bones on top of the foot. To do this, we must stop the arch from collapsing. The most effective method is to use an orthotic that conforms very closely to the arch of the foot called a total contact orthotic. If the arch of the orthotic gaps away from the arch of the foot, then the orthotic will not effectively reduce the pressure or your pain.


Stress Fractures on Top of the Foot

A stress fracture of a metatarsal bone or tarsal bone can cause pain on the top of your foot. This is easily evaluated in an appointment with Dr. Shirazi.


Midfoot Arthritis

Foot arthritis between the bones on the top of your feet can also lead to pain. Midfoot arthritis, simply put, is damage to the joints in the middle of your foot. You can see in the x-ray that the joints have worn away. Common causes of midfoot arthritis include:

  • Flat foot

  • Carrying excess weight

  • Trauma (broken bone or bad sprain)

Flat foot and obesity are the most common causes of this type of arthritis – they both force the foot to flatten which forces the bones on the top of the foot together. Over time, this increased pressure damages the joints. To eliminate the pain, we have to support the foot and decrease or eliminate motion of the damaged joints.

This can be done with the use of a very specific type of foot orthotic, shoe changes and modifications or through surgical fusion of the joints of the midfoot. Surgery should only be considered as a very last resort. Midfoot arthritis should be treated professionally so we can protect your joints now to stop or slow further joint damage.

One of the most effective treatments is a total contact custom orthotic that conforms extremely closely to the arch to reduce midfoot motion and decrease pain. Motion causes pain in arthritic joints. Limiting motion can limit pain. Prefabricated orthotics won’t provide enough support to protect joints because they gap away from the arch and allow it to flatten. This increases pain by allowing too much motion.

In addition to total contact orthotics, other treatments for arthritis of the top of the foot include ankle foot orthotics or rocker bottom shoes. Surgery is also a possibility but should be considered only as a last resort. This is a philosophy of Dr. Shirazi - to always begin with conservative modalities of treatment until surgery is necessary.


Proper Midfoot Arthritis and Top of Foot Pain Orthotics

An effective orthotic must be made from a laser scan or foot cast taken with the foot not bearing any weight at all. If the doctor allows the foot to bear weight while the image is taken, the force will cause the arch to flatten so the orthotic made from this cast will not conform closely to the arch of the foot.


Total contact orthotic


Dr. Sara Shirazi will take a 3D scan of your foot, not an assistant. Proper positioning of the foot is critical to the best outcome. If they assign an assistant to cast your foot, cancel the appointment. If they want to put your foot in a foam box, cancel the appointment. If they want you to step on pressure map at a running shoe stores - cancel the appointment!


In order to limit motion in the painful joints at the top of the foot, the orthotic must conform very close to the arch of the foot.


Also, the podiatrist must write an effective and specific orthotic prescription that tells the orthotic lab how to make the orthotic in a manner that limits the motion of the arthritic joints in your feet.

Finally, the doctor must use a very high quality orthotic lab. Some labs are good but, unfortunately, there are many labs with poor standards who are constantly cutting their costs and offering low quality products. Many orthotics are made with arches that are excessively flat or too rigid, and these devices will not do a good job of limiting painful foot motion.


Treating Top of Foot Pain Conservatively and Avoiding Surgery

In the case of dorsal compression, when the foot flattens as you step, the bones on top of the foot compress together which causes pain. The first goal in treating this pain is to limit flattening of the arch so the bones won’t compress against each other. Proper arch supports (in the form of custom orthotics) and proper shoe gear help drastically.


Also, avoid going barefoot – even around the house. We may also recommend topical pain relievers and icing. If you take this advice and follow our home treatment plan below, you should experience relief within a week or two if you have dorsal compression. Even if you have foot arthritis, these changes should help bring some pain relief.


Self-Treatment Plan to Relieve Top of Foot Pain

Before you start this home therapy plan for pain on the top of your foot, you should make sure you do not have a stress fracture. Forefoot pain with swelling are symptoms of stress fracture. We recommend you follow this plan for three weeks. Most people will see relief within the first week or two. If your pain isn’t gone after three weeks, contact us to discuss other treatment alternatives.


1. Use an arch support in your shoes

Use an arch support that matches your arch as close as possible. The closer the arch support conforms to the arch of your foot the better it will be at decreasing pressure between the joints on top of your foot.

We recommend supports with higher arches and some rigidity.

The best OTC support we have found for top of foot pain and foot arthritis is offered at our office.


2. Use a flip-flop, slipper or sandal with arch support at home

Walking around barefoot allows arch collapse that increases pressure between the bones on top of the foot. We recommend you wear slippers or sandals with an arch support while at home. Vionic sandals, or Birkenstocks provide outstanding arch support and are perfect for anyone prone to foot problems such as heel pain, ball-of-foot pain, big toe joint pain, tendonitis and overall tired feet. These healthy sandal options combines orthotic treatment and comfort in stylish and sporty sandals.


3. Ice the foot

Daily icing can also help top of foot pain. At the end of the day, elevate your foot and ice it for 10 minutes each evening. This can reduce pain and swelling caused by arthritis, dorsal compression or injuries.


4. Topical pain relief

Non-prescription topical analgesics offer relief for many top of foot pain patients. We recommend BioFreeze which provides relief in a couple of different ways. The cold sensation can help address pain and the glucosamine and other ingredients work together to help achieve pain relief in some cases. This gel is well-reviewed, particularly among those with arthritis.


5. Choose stable shoes and add an exceptional arch support

  • Stability – A stable shoe will support your foot and keep it from flattening. Shoes should have a firm heel and torsional (anti-twisting) stability. This prevents the heels from rolling inward and the foot from flattening too much, which leads to bones compression. Ask the doctor for her recommended favorites!

  • Deeper Than Average Shoes – Shoe depth makes a difference because it reduces pressure on the top of the foot.

Don’t live with pain on the top of your foot. Call 626-517-0022 to schedule an appointment with our board-certified foot and ankle expert, Dr. Sara Shirazi, for fast and effective relief of your top of foot pain no matter the cause.



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