Laces too tight? Or, is there another reason for pain on the top of your foot?

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Laces too tight?  Or, is there another reason for pain on the top of your foot?

Pain on the top of the foot is very common in runners.  Often, runners think that they’ve tied their laces too tightly and loosen them, or try alternative lacing techniques to see if it helps, but in many cases it doesn’t.

This month, Rebecca Nelson, Director of Physio at Apex Clinic wants to help get to the bottom of what is making the top of your foot ache and how to cure it.

The TWO most common causes of pain on the top of the foot in runners are:

1.  Altered neurodynamics, which means  poor movement of the nerves on the top of the foot, namely the superficial and deep peroneal nerves:

A sure way of knowing that you are suffering from altered neurodynamics, is if your pain worsens by pointing your foot downwards, as the nerves on the top of the foot are tugged or lengthened.  This pain is usually localised to the nerves travelling down the top of the foot from the ankle to the base of the toes.

Pain caused by altered neurodynamics is exacerbated by faster running and running with a greater stride length, such as down hill running.  It can’t be cleared with self-management strategies, but usually clears completely following physiotherapy treatment with an experienced spinal and nerve pain physio.

2.  Referred pain from the lower back: 

This pain is usually poorly localised, diffuse and difficult to pinpoint exactly.   You don’t need to have any back pain for the pain to be coming from your lower back.  It is usually worsened by uphill running but not usually by faster running.  If it is bad enough, this pain may be present on getting up after prolonged sitting or driving, or for the first few steps of walking.  It can’t be cleared with self-management strategies, but usually clears completely following physio treatment with a physio experienced in treating spinal problems and nerve pain.

Other less common causes of pain on the top of the foot in runners are:

Local overuse injuries relating to muscle, tendon or bone/stress fracture:

Although in fact less common, overuse injuries such as tendinitis or muscle strains, are the most over-diagnosed causes of pain on the top of the foot in runners.

If foot pain is caused by an overuse injury, often the person has poor foot biomechanics or poor foot function.   The person’s foot biomechanics should be assessed to see if over-the-counter or custom-made insoles are needed.  In cases where appropriate insoles have already been worn and the pain continues, then it is unlikely that the pain stems from an overuse injury.

Pain from a tendon problem, tendinitis or tendinosis, typically presents as very localised pain to the affected tendon.  It is not a widespread pain and is easy for the person to identify exactly where the pain is located.  Stress fractures, which are also a less common cause of this type of pain, typically present with local bony tenderness on palpation with associated swelling. Stress fractures would be confirmed by an x-ray or bone scan.

Entrapment of the superficial peroneal nerve on the top of the foot:

A rare occurrence, the superficial peroneal nerve (the nerve passing along the top of the foot) may become entrapped by external forces such as constrictive footwear, either trainers that are too tight or tied too tightly.  Larger trainers or tying your trainers less tightly may cure this pain.

Our Christmas message to all the NI runners out there is, as ever, not to suffer in silence but rather to take action fast against pain before it stops you.

From all the team at Apex Clinic, we wish you a pain-free and peaceful Christmas!