How Runners Can Prevent Top of Foot Pain

foot pain
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A common complaint among runners is pain on the top of the foot, right under your shoelaces. In many cases, pain on the top of the foot is due to an inflammation of the extensor tendons, which run along the top of your foot and give you the ability to straighten your toes. Inflammation of those tendons is called foot extensor tendonitis.

Symptoms of Foot Extensor Tendonitis

If you’re dealing with extensor tendonitis, you’ll feel pain on the top of your foot as you’re running.

You may see swelling on the top of your foot and notice a large bump somewhere along the tendon.

A simple test to determine if the pain on the top of your foot is a result of extensor tendonitis is to flex your foot downward and push down on your toes. (It’s more effective if you have someone else provide the resistance on your toes, rather than doing it yourself.) Then, try to pull your toes up against the resistance. If you're feeling pain across the top of your foot or along the extensor tendon when you're doing that, then you’re most likely dealing with extensor tendonitis.

Causes of Foot Extensor Tendonitis

Some common factors that may lead to extensor tendonitis are very tight calf muscles, overtraining, and falling of your foot arch.

Extensor tendonitis can also be caused by lacing your shoes too tight or wearing shoes that are too small or don’t fit properly. Check your running shoes to see if they’re creating a pressure point along the top of your foot.

For some runners, non-running shoes are the problem, so be sure you’re wearing comfortable shoes that fit properly when you’re not running.

Another possible cause could be a change in your running habits or training. Doing a lot of uphill running, especially on a treadmill, can place more stress on your foot extensor tendons and lead to inflammation.

Treatment for Foot Extensor Tendonitis

For mild extensor tendonitis, the most effective treatments are stretching your calf muscle and reducing the inflammation with ice or anti-inflammatories (Talk to your health care provide to see if you should take anti-inflammatories.) In addition to stretching your calves, you can also try self-massage using a foam roller or other massage tool. Once the extensor tendon is no longer inflamed, you’ll be able to run relatively pain-free.

You can also try changing your shoe lacing pattern and loosening your laces slightly. To relieve pressure on the top of your foot, try lacing your shoes across the shoe tongue in a ladder pattern, rather than in a typical criss-cross pattern.

In some more extreme cases, a podiatrist may recommend custom-made orthotics or another treatment, especially if you're dealing with fallen arches.

It's usually safe to run through foot extensor tendonitis if the pain is mild and it’s not affecting your gait. If you do find running to be too painful, even after changing your shoe lacing, take a couple of days off from running before you attempt it again.

Like many minor running overuse injuries, extensor tendonitis often clears up after a few days of rest, especially if you catch it early.

What’s If It’s Not Foot Extensor Tendonitis?

If your pain doesn’t go away after trying the above treatments, you may be dealing with a different injury or condition. Other conditions with similar symptoms include metatarsal stress fractures, atypical gout, and degenerative arthritis. Consult your podiatrist or other health care professional to determine the exact diagnosis and next steps.

Source:  FootCareMD, American Orthopaedic Foot & Ankle Society,

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