Top of foot pain & swelling

by Suki
(Sri Lanka )

3 months ago I had pain on top of my right foot, about an inch from 2 & 3 toes. I am an active 52 year old female. I do a lot of brisk walking & gardening. But i do not remember hurting my foot there. I found my self limping but continued being active on my feet. 2 weeks later there was a slight swelling, painful if pressed. A month later I saw my doctor who took an X-ray but it was ok. He tested me for gout, but that was negative. i dont have high blood pressure or diabetes. He prescribed aceclofenac 100mg twice daily. Now three months later I am still on aceclofenac, still limping & since two days ago there is swelling further up on my foot.

RESPONSE

Hi Suki,

I will start off by discussing to the two most common causes of pain on top of the foot in the area just behind the toes.

The first would be what is known as an extensor tendonitis, which is an inflammation of the tendons that bend your toes upwards. Typically this can happen from nothing more than walking; there does not have to be any history of trauma to the foot.

The problem here is that as you continue to walk you are essentially re-injuring the area every time you take a step, thus the foot never gets the chance to heal. If for example you had a similar injury on top of your hand, you would keep the hand in a sling for a week to ten days, basically resting the area and the hand would get better. The fact that you have to continue to walk further exacerbates the problem.

One would have thought the anti-inflammatory medication you are on would have helped, but I have seen many times over the years that medication alone may not do the job. Usually immobilization, along with physical therapy is necessary to finally get the foot to stop hurting.

The other possibility that is going on here and the one I am leaning more towards simply based on the amount of time that has passed is a stress fracture.

I know you had an x-ray about six weeks after you first felt pain and the x-ray was negative. At this point I would suggest another x-ray and if that x-ray also proves to be negative, I would talk to your doctor about a bone scan which can pick up small fractures that an x-ray may miss.

Tendonitis and stress fractures are probably the two most common causes of pain in that area of the foot. A third, less common possibility would be a superficial phlebitis which is an inflammation of one of the superficial veins that courses through that section of the foot. Typically, the area will be swollen, red, and even warm to touch.

Since so much time has passed and you are still having significant pain, another trip to your doctor would certainly be indicated.

Marc Mitnick DPM
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