Pain across the top of the foot, known as the dorsum, often causes concern about a pulled muscle. The dorsum is dominated by a complex network of bones, ligaments, and long tendons that connect to muscles located in the lower leg. While the area is not primarily muscular, true muscle strains are possible due to the presence of small, intrinsic muscles. However, these strains are statistically less frequent than other common injuries in this region.
The Structures: Can a Muscle Strain Occur?
The dorsum contains structures categorized as intrinsic, meaning they originate and insert entirely within the foot, and extrinsic, which originate in the lower leg. A true muscle strain involves the tearing of muscle fibers, which can occur in the small intrinsic muscles located on the top of the foot. The most prominent of these is the Extensor Digitorum Brevis (EDB) and its medial part, the Extensor Hallucis Brevis.
The EDB is a small, fleshy muscle that helps extend the second through fourth toes and is located on the outer, upper portion of the foot. Because of its location and function, this muscle can be strained, especially during repetitive activities involving forceful toe lifting. However, the majority of visible structures crossing the foot are long, cord-like tendons, such as the Extensor Digitorum Longus and Extensor Hallucis Longus. Pain originating from these tendons is categorized as tendinopathy, which is an injury to the tendon, not the muscle belly itself.
What Is More Likely: Common Causes of Dorsal Foot Pain
Because the muscle belly of the EDB is relatively small and protected, the most common causes of dorsal foot pain involve the surrounding tendons, bones, and joints. The leading cause is Extensor Tendonitis, which is inflammation of the long tendons running from the lower leg across the ankle and onto the top of the foot. This condition often results from overuse, such as increasing running distance too quickly, or from mechanical pressure, like wearing shoes that are too tight or laced too firmly across the foot’s arch.
A frequent cause of pain is a stress fracture, a tiny crack in a bone, most commonly the metatarsals, caused by repetitive force. Stress fractures are common in individuals engaging in high-impact activities like running and jumping, presenting with sudden swelling and localized tenderness. Midfoot pain may also relate to a ligament sprain, which involves damage to the tough, fibrous connective tissue stabilizing the joints. Other causes include structural issues like bone spurs or inflammatory conditions such as gout.
Immediate Relief and Short-Term Management
For acute pain on the top of the foot, regardless of whether the injury is a muscle strain or tendon irritation, immediate management should focus on reducing inflammation and preventing further damage. The standard initial approach for most soft tissue injuries is the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Rest involves avoiding any activity that causes pain, which often includes avoiding walking or standing for long periods.
Apply ice to the painful area for 15 to 20 minutes at a time to limit swelling and numb the pain, using a towel between the ice pack and the skin. Compression, using an elastic bandage, helps control swelling but must be applied carefully to avoid cutting off circulation; tingling or numbness indicates the wrap is too tight. Elevating the foot above the level of the heart uses gravity to promote drainage and reduce fluid pooling.
Identifying When to See a Doctor
While R.I.C.E. can manage many minor sprains or cases of tendonitis, certain signs indicate the need for professional medical evaluation. Seek immediate care if you are unable to bear weight on the foot, even for a short period, or if the pain is severe and rapidly worsening. Persistent pain that does not improve after 48 hours of consistent home care should also prompt a visit to a healthcare provider.
Other warning signs include severe or persistent swelling, a noticeable deformity of the foot, or any sensation of numbness or tingling, which suggests potential nerve involvement. A physician can properly diagnose the underlying cause, distinguishing between a rare muscle strain, a common case of tendonitis, a stress fracture, or another condition.