Foot pain on top of the foot

by Susan
(Brooklyn, NY)

A few weeks ago, I came home from work, took off my shoes, and noticed my left foot was a little swollen on top. no pain or anything. The pain I have on the top of my foot started as a slight discomfort, then it went away. I excercise alternating between an eliptical and treadmill 4 days a week. Last week the morning after using the eliptical, the discomfort was back progressing into an ache. Now it hurts when I walk and its slightly swollen. (not noticable unless your comparing that foot with my other.) I tried soaking it in epsom salt, but in didn't help. Any ideas on what it might be or what caused it? Thanks.

RESPONSE

Hi Susan,

The one thing we do know is that your foot problem seemed to worsen after exercise on the elliptical. You do mention, however, that you had a slight twinge of discomfort in the same area after returning home from work, but this pain went away.
The reason I bother to rehash your history is that it is important to note that you started to have the pain, but then it disappeared, only to return after exercise. Because the pain actually disappeared I am not inclined to think that you may have a stress fracture in your foot, which is always a consideration when there is pain on the top of the foot for no real apparent reason.
Without the luxury of actually examining you, this leaves me with two other possibilities.
One would be a midtarsal fault which you can read about. (See the navigation choices to the left). This is basically from a foot that collapses or flattens out too much in gait. Because of this over flattening you end up with a jamming effect between the two bones that make up the highest point on your arch. This jamming effect will eventually cause an arthritic flare up on the top of the foot and thus will yield pain.
The other possibility and probably the more likely possibility would be tendonitis of one of the extensor tendons on the top of your foot. These are the tendons that lift your toes upward.
Sometimes an extended amount of walking or exercise will over work these tendons and they will become inflamed causing swelling and pain on the top of the foot.
Sometimes a certain shoe, one that puts too much pressure on the top of the foot or a pump, where the end of the top of the shoe "cuts" into the foot will also cause a tendonitis.
The problem with these types of foot problems are that you have to identify the causative factors, such as activity, shoe type, etc. and eliminate them for the time being so the foot can heal. The problem with feet is that every time you take a step, you are basically re-injuring an injured area and therefore foot pain can take forever to heal.
If your pain is severe enough and has lasted for at least a week with no real reduction in pain, I would suggest you see a foot specialist in your area, have an x-ray and an evaluation and then get an accurate diagnosis and proper treatment.

Marc Mitnick DPM
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