My advice for ‘top of foot pain’

Top of foot pain is becoming a more common running injury with the trend to barefoot and minimalist running. The cause of the problem is due to the constant load on the forefoot dorsiflexing the forefoot on the rearfoot and trying to lower the arch. This results in a jamming of the joints and bones on the top of the arch causing the top of foot pain. Technically, this is referred to as dorsal midfoot interosseous compression syndrome.


My Advice if you have top of foot pain:

  • Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming)
  • Get back to heel strike running to reduce the load (you can worry about transitioning back to the forefoot later when it is all healed)
  • Use a heel raise (this helps lower the forefoot); also do even more stretching for the calf muscles as this contributes to the problem if they are tight.
  • Foot orthotics with the right design features are very effective at treating this problem. The foot orthotics has to be designed in such a way that they allow the forefoot to plantarflex relative to the rearfoot or they will not help


Long term:

You can transition back to forefoot striking and away from foot orthotics very gradually and very slowly and very carefully so the tissues can adapt to the loads. However, in some runners the loads causing the top of foot pain are so high the tissues cannot adapt to the load. In that case, the heel striking and the foot orthotics need to be seen as long term options.

For more information:
‘Top of foot pain’ Management in barefoot Runners