top of foot pain at night

by Michelle
(Mt. Zion, IL, USA)

As a female slight body frame, about 15#'s overweight, menopausal with surgical hypothyroidism, I use to run, but had trouble with a bone spur on the bottom of my foot. That has resolved, but now at night I will have a "nagging" irritation on the top of my foot. It is intermittent, sometimes not having the irritation for many nights in a row, then it will irritate me other nights and wake me up. I have extremely high arches and wear inserts in all my shoes and try to never so bare-foot. But the nights that I have this problem, the next day it feels better to go bare-foot, because the top of the tennis shoes "rub"/constrict where my foot is irritated. There is no redness or swelling. Rubbing it or applying topical anesthetic does not help the irritation to go away. It goes away during the day, but wakes me/keeps me awake during the night, no matter what position I move my foot to try to relieve it.

RESPONSE

Hi Michelle,

Typically, people with high arched feet have trouble from shoes that press on the top portion of the foot. This can occur in both dress shoes and casual shoes like sneakers.

Additionally, people with arched feet require the use of orthotics simply to prevent the foot from collapsing over time as well as preventing specific pedal conditions.

Thus the combination of wearing an orthotic in a shoe may create a pressure point on the top portion of the foot.

There are a couple of ways to go here. The simplest and most conservative would be to place a doughnut shaped pad on the top of your foot with the hole around the area of pain.

Dr. Scholls sells one which is somewhat orange in color and has an adhesive back to it. Make sure you change it everyday and you could eventually end up with a reaction to the adhesive if you leave one pad on for long periods of time.

As you can readily imagine, this will keep the shoe pressure off the top of the foot which is being irritated in your shoe.

Over time this should help alleviate the problem.

Now, if the pain is disabling when it occurs, you might want to see a foot specialist. On the top portion of your foot, just under the skin is a group of tendons, blood vessels and sensory nerves.

When the top of your foot is pressed against the top of the shoe, any one or all of these structures may be irritated and that would be what is giving you your pain. So, a cortisone injection into the area can be very helpful. Just keep in mind if you continue to allow your shoes to press into the bone, the problem will most likely return.

Rather then rubbing the area of applying anesthetic ointment, try icing the area instead. That might give you better temporary relief.

My only other thought is that perhaps your orthotics are not supporting your feet enough and you are experiencing a midtarsal fault where the arch actually collapses and the bones on top of your foot jam into each other and cause your pain. You can read my section on midtarsal fault.

Marc Mitnick DPM
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