What causes pain on top of the foot?

A common cause is extensor tendonitis, an irritation of the tendons that lift the toes where they run under the laces, after tight laces, new shoes or more walking or running. A metatarsal stress fracture, a Lisfranc injury, gout, a ganglion, a pinched nerve and midfoot arthritis can also hurt there.

How should I lace my shoes for pain on top of the foot?

Lace as usual up to the eyelets below the sore spot, run the lace up the inside on both sides to skip a pair, then cross again above it. That leaves a window with no lace across the tendon. Lacing in straight bars instead of criss-crossing also keeps crossing points off the tendon.

Pain on Top of the Foot: Tendon or Bone?

Written by Zita Sham, Principal Physiotherapist at Phoenix Rehab, AHPC A1302159H.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 8 October 2026.

Pain on top of the foot is often extensor tendonitis: the tendons that lift your toes, irritated where they run under your laces. Tight laces, new shoes and a jump in walking or running are the usual triggers. A stress fracture, a midfoot sprain, gout or a pinched nerve can feel similar, and each needs something different first.

Key takeaways

Extensor tendonitis, also called extensor tendinopathy, is an irritation of the tendons that lift the toes and the front of the foot, where they cross the top of the foot under the laces.
It usually aches along a line that follows the tendon, and it hurts more when you lift your toes against resistance. Pain at one spot on a bone, worse with every run or walk, needs a doctor the same day.
A twist or a foot trodden on, with pain across the middle of the foot and bruising on the sole, can be a Lisfranc injury and needs a doctor the same day.
A joint that turns red, hot and swollen within hours, with no injury, is more often gout and needs a doctor the same day.
Skipping the eyelets over the sore spot, or lacing straight across, takes the pressure of the laces off the tendons.
We measure the ankle bend, the calf and the toe lifters against the other foot before running, hills and long shifts come back.

What is extensor tendonitis of the foot?

Three tendons cross the front of the ankle onto the top of the foot. The thickest, tibialis anterior, runs to the inner side of the midfoot and lifts the foot as you step. Extensor hallucis longus runs to the big toe. Extensor digitorum longus splits into four and runs to the smaller toes. At the front of the ankle all three pass under the extensor retinaculum, a band of tissue that holds them flat against the bones. From there they run over the top of the foot, under the tongue of your shoe and the laces.

Those tendons glide on every step. Press on them from above with a tight lace, a stiff tongue or a boot that creases across the foot, and ask them to work harder on hills, stairs and long days, and the tendon and the sheath around it get irritated. Doctors and physiotherapists call it extensor tendinopathy or extensor tendonitis. Tibialis anterior tendinopathy is the same problem in the biggest of the three.

What does extensor tendonitis in the foot feel like?

An ache along the top of the foot, where the laces sit, that follows a line toward the toes. It is often worse at the start of a walk or a run, eases as you warm up, and comes back afterward. Lifting your toes up against your other hand hurts. By evening some people see a puffy ridge along the tendon, and pulling the laces tight in the morning is the moment it bites. Some feel a creak under their fingers as they move the toes.

Can you still walk with extensor tendonitis?

Usually, yes. Most people walk on it and ache more with distance, hills and stairs. If you cannot take four steps on the foot, or one spot on a bone hurts to press, a doctor sees you first. Walking shorter distances in a shoe that does not press on the sore spot keeps the foot moving while the tendon settles.

How it starts, in the order to check

1. Laces and shoes

A new pair of running shoes with a thin tongue. Laces pulled tight for a race or a hike. Steel-toe safety boots, or a stiff new pair of work shoes that crease across the top of the foot. Ask what changed on your feet just before it started. The answer is often in the shoe rack.

2. A jump in running or walking

A marathon block that added a long run. A new route with hills, or the overhead bridges and the stairs at the MRT station where you used to take the lift. A holiday spent walking all day in sandals or new sneakers. Runners will find it listed in running injuries.

3. Long hours on your feet at work

A shift on a concrete floor in boots. Kneeling and squatting on site, which bend the ankle to its limit and press the crease of the boot into the top of the foot. Ladders, which load the front of the foot rung by rung. Covered in construction worker injuries.

4. Court and studio

Badminton footwork: the lunge to the net, the push back, the split step, hour after hour in court shoes laced tight. See badminton injuries. Dancers point and flex the foot for hours, and a tight strap across the top of the foot sits where a lace would. See dance injuries.

In each case there is a change in what the foot is asked to do, and no single moment. A foot that hurt from one moment, a twist, a fall or a weight dropped on it, is a different story. Start with the table below.

Extensor tendonitis, stress fracture, Lisfranc injury, gout or something else?

Ask three things: did it start in one moment, does it hurt along a line or at one spot on a bone, and did it come on within hours.

Condition	How it started	What you notice	What it needs first
Extensor tendonitis (extensor tendinopathy)	Over days or weeks, after new shoes, tight laces, more walking or running, or hills	An ache along a line on top of the foot, worse lifting the toes against resistance. Sometimes a puffy ridge by evening	The laces off the sore spot and the load changed. A physiotherapist if it keeps coming back
Metatarsal stress fracture	Weeks of running, marching or walking further than before	Pain at one spot on a bone you can cover with a fingertip, worse with every run or walk, often with swelling. Most often the second or third metatarsal. Nearer the ankle it can be the navicular	A doctor the same day. Hopping on that foot to test it is a decision for the doctor
Lisfranc injury (midfoot sprain or fracture)	One moment: a twist on a pointed foot, a fall, or a foot trodden on	Pain and swelling across the middle of the foot, where the laces sit. Bruising on the sole of the midfoot is a recognized warning sign²	A doctor the same day, and imaging
Ganglion on top of the foot	Over weeks, often with no injury	A smooth, rubbery lump on top of the foot that the shoe rubs on. It can change size	A doctor soon, to confirm what the lump is
Gout	Within hours, often overnight, with no injury	A joint that is red, hot, swollen and too painful to touch. Usually the big toe, and it can be the midfoot	A doctor the same day
Nerve compression on top of the foot (superficial or deep peroneal nerve)	Tight laces, tight boots, or a swollen foot in a shoe	Tingling, burning or numbness on top of the foot. The deep peroneal nerve gives a numb patch between the big toe and the second toe	Loosen the laces. A doctor soon if it does not ease
Arthritis of the midfoot	Slowly, over months or years, more often in older adults	A stiff, aching midfoot after standing, and often a bony bump on top that the shoe presses on	A doctor and an X-ray to confirm it, then shoes and loading
Bump on top of the big toe joint	Slowly, with a stiff big toe	A bony bump on top of the big toe joint, sore at push-off and in tight shoes. See hallux rigidus	A doctor and an X-ray to confirm it
Sprained ankle that tracks forward	One moment: you rolled the ankle	Pain and swelling around the outer ankle bone first, then bruising that drains down onto the top of the foot and the toes over the next days	A doctor if you cannot take four steps, or the bone hurts to press. Then a physiotherapist

A line of pain across the front of the ankle itself, rather than the foot, can be the same tendons higher up, covered in ankle tenosynovitis. Burning or numbness into the sole is a different nerve, covered in tarsal tunnel syndrome.

Can gout affect the top of the foot?

Yes. Gout most often starts at the big toe joint, and it can also flare in the joints of the midfoot and the ankle. It comes on fast, often overnight, with heat, redness and swelling, and the bed sheet hurts to touch. A doctor diagnoses gout and decides on any treatment. A hot, red, swollen joint with a fever is a different matter and needs the emergency department.

Tendon or bone? How doctors decide on an X-ray

After an injury, emergency doctors often use the Ottawa foot rules to decide who needs an X-ray of the midfoot. In the study that set them out, an X-ray was advised for bone tenderness at the navicular, on the inner side of the midfoot, or at the base of the fifth metatarsal, on the outer edge of the foot, or if the person could not take four steps both straight after the injury and when examined. Limping counted as taking a step.¹

The rules were built for injuries in one moment. A stress fracture builds up over weeks, and an early one may not show on the first X-ray. Pain at one spot on a bone that is worse with every run is a question for a doctor, whatever an X-ray showed before. Which scan you need, and when, is a decision for your doctor.

Why your laces matter, and how to re-lace

The laces sit right over the tendons. Each time you pull them tight, the tongue presses the tendons against the bones of the midfoot, and on every step the tendons slide under that pressure. Changing the lacing is one of the few things that takes pressure off on day one.

Skip the eyelets over the sore spot. Unlace the shoe. Lace as usual up to the eyelets below the sore spot, then run the lace up the inside on both sides, skipping a pair, and cross again above it. The gap leaves a window with no lace across the tendon.
Lace straight across. Run the lace in straight bars from side to side instead of criss-crossing, so no crossing point sits on the tendon.
Check the tongue. A thin tongue or one that slides to the side lets the laces dig in. A shoe with a padded tongue, or a soft pad under the laces, spreads the pressure.
Check the crease. A stiff new boot creases across the top of the foot when you bend your toes. If the crease lands on the sore spot, the boot is part of the problem.

For safety boots at work, the lacing changes still apply. If your employer issues the boots, ask whether another size or model is available. Insoles change how the foot sits in the shoe, and are covered in custom insoles.

How long does extensor tendonitis take to settle?

No good study puts a number of weeks on it, so we do not guess. It settles as the pressure comes off and as the load the tendon can take goes up. The order is usually the same: the morning ache when you lace up goes first, then the ridge by evening, then the ache on hills and stairs. The run, the long shift in boots and the full badminton game come back last.

Extensor tendonitis treatment: who does what

A doctor (your GP, a polyclinic doctor or the emergency department) examines the foot, rules out a fracture, a Lisfranc injury, gout and infection, and decides on any X-ray, scan, blood test, medication or injection.
An orthopedic surgeon sees the injuries that may need an operation, such as an unstable Lisfranc injury or a stress fracture at a high-risk site, and decides on the treatment.
A podiatrist can assess your feet and shoes and make insoles. Some people see one first for foot pain.
A physiotherapist finds which tendon is irritated and whether the bone or a nerve is involved, takes the pressure and load off, measures the ankle, the calf and the toe lifters against the other foot, and loads them back in stages. If the pain sits on a bone or does not behave like a tendon, we refer you back to your doctor.

The four stages for pain on top of the foot

In the Phoenix Recovery Protocol the work starts at Calm & Protect: the laces and the shoes changed, the hills and the long runs taken out, and the walking kept. Move & Mobilize brings the ankle bend and the toe movement back toward the other foot, and gets you up and down the stairs without the ache. Rebuild & Strengthen loads the muscles at the front of the shin and the toe lifters, then the calf, one leg at a time. Return & Perform tests the tasks themselves: the hill run, the race distance, the badminton lunge, the full shift in boots, kneeling on site.

What we measure

Where it hurts to press. Along the tendon, or over one spot on a bone. Bone tenderness goes back to a doctor.
Toe and foot lifting strength. Lifting the toes and the front of the foot against resistance, each side, for pain and for strength.
Ankle bend. The knee-to-wall lunge, in centimeters, against the other foot.
Calf. Single-leg calf raises, counted on each side.
Hopping. Single-leg hops, counted on each side, only once a doctor has ruled out a fracture.
Walking and running. How many minutes you walk or run before the ache starts, on the flat and on a slope.
Your shoes. Bring the pair you wear most, and the pair you wore when it started. We look at the tongue, the crease and the lacing.

Tested, not dated. The plan moves on when the measures say so.

What you can do this week

If one spot on a bone hurts to press, or you cannot take four steps, stop running and see a doctor first.
Re-lace the shoes you wear most: skip the eyelets over the sore spot, or lace straight across.
Wear the pair that does not press on the sore spot, and leave the new or stiff pair in the cupboard for now.
Keep walking. Take the hills, the stairs and the long runs out, and keep flat walking or easy running if the ache stays mild and is no worse the next morning.
Raise the foot at the end of the day if it puffs up by evening. A cold pack wrapped in a cloth, in short spells, if it helps.
Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.

Is this normal?

Usually expected: an ache along the top of the foot that is worse when you first lace up or set off and eases as you warm up. A puffy ridge along the tendon by evening that goes down overnight. An ache after a long walk or a hill that settles by the next morning. A foot that eases week by week once the laces and the load change.

Worth getting checked: an ache that has not changed in a few weeks despite new laces and less load. Pain that comes back every time you return to running, badminton or a full shift. Numbness on top of the foot that stays after the laces are loosened. A lump on top of the foot.

When to see a doctor first

Call 995 if bone is showing through the skin after an injury to the foot, if a wound is bleeding heavily and firm pressure does not slow it, or for chest pain or sudden breathlessness while in a cast or boot, or in the weeks after foot surgery.
Go to the emergency department now if you cannot take four steps on the foot after a twist, a fall or a crush, or the foot looks out of shape. Also if the foot turns cold, pale or blue, if the foot is red, hot and swollen and you have a fever, shivers or feel unwell, which can be an infection, or if a calf becomes newly swollen, warm and tender while in a cast or boot. If you have diabetes, go now for a foot that becomes red, hot or swollen, or a wound on the foot with pus or spreading redness.
See a doctor the same day for pain at one spot on a bone on top of the foot that is worse with each run or walk, which can be a stress fracture. Also for a joint that turns red, hot, swollen and too painful to touch within hours, without a fever, which is more often gout. Also after a twist or a foot trodden on, for pain across the middle of the foot with bruising on the sole, even if you can walk, or for bone that hurts to press at the navicular or at the base of the fifth metatarsal.
See a doctor soon for numbness or tingling on top of the foot that does not ease when the laces are loosened, a lump on top of the foot, a stiff, aching midfoot with a bony bump that a doctor has not examined, or aching and swelling in several joints with morning stiffness. Burning or numbness into the sole is covered in tarsal tunnel syndrome.

Where are you with this right now?

1. It is easing since you changed the laces

It started after the new shoes or the hill block. You skipped the eyelets over the sore spot, took the hills out, and the ache when you lace up has eased week by week. The ridge by evening is smaller, and the flat run no longer aches. That is a tendon behaving as many do. Bring the hills back before the race pace, and the race pace before the long run. You do not need us for this, and we would rather say so.

2. The laces are loose, and the top of the foot still aches

Six weeks since the new safety boots, or since the long run went up for the marathon.

You wince as you pull the laces tight, then loosen them before you reach the lift. By evening there is a puffy ridge across the top of the foot, and the sock leaves a line in it. The MRT stairs at Raffles Place are fine going up and ache coming down. You have sat out the Saturday badminton three weeks running, and at the office you have swapped to slippers under the desk.

Loose laces and rest made sense for the first week. In your own weeks since, the ridge still comes up by evening and the ache still comes back on the first hill.

The swelling goes down overnight. Has anyone measured how far that ankle bends and how many calf raises that foot can do against the other one?

If one spot on a bone hurts to press, or the foot is red and hot, a doctor sees you first. If your doctor has ruled those out, one Assessment & Treatment with a physiotherapist checks the tendon against the bone, measures the ankle bend, the calf and the toe lifters against the other foot, looks at your shoes and lacing, treats what is limiting you in the same visit, and tells you which stage you are in.

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3. You have had a foot fracture or foot surgery

The top of the foot often aches after a foot fracture, a Lisfranc injury or an operation on the foot or ankle: the swelling, the weeks in a boot and the first weeks back in a shoe all press on the same tendons. Your surgeon sets what the foot takes and when, and we work inside those limits. See foot fractures, Lisfranc injury and physiotherapy after surgery. Your surgeon’s protocol takes precedence.

If it is months on and you still limp, still cannot lace the shoe without the ache, or the calf on that side is still well short of the other one, the Stalled Recovery Review is three weeks with the same physiotherapist. The first visit measures the ankle, the calf, the toe lifters and your walk. The next two measure how they respond.

All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.

Next step

Find out which stage you are in

Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.

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