Pain when lifting the toes, known as dorsiflexion, often originates from structures within the lower leg, ankle, or foot. While sometimes minor, this pain can signal an underlying condition that warrants attention.
Common Causes of Pain When Lifting Toes
Tibialis anterior tendinopathy or strain is a frequent cause of pain when lifting toes. The tibialis anterior muscle, located along the front of the shin, primarily lifts the foot and toes. Overuse, repetitive strain from activities like running, jumping, or improper footwear can inflame this tendon, causing pain and stiffness during dorsiflexion or uphill walking. Pain often develops gradually along the front of the ankle and shin, sometimes with swelling.
Extensor tendinitis, inflammation of tendons on the top of the foot that lift the toes, is another common issue. These tendons, like the extensor hallucis longus for the big toe and extensor digitorum for other toes, are irritated by tight shoes, prolonged weight-bearing, or repetitive motions. Pain typically worsens with activity and may include swelling or tenderness across the top of the foot.
Nerve impingement, such as peroneal nerve entrapment, can cause pain, numbness, or weakness when lifting the toes. The common peroneal nerve branches down the leg, controlling muscles that lift the ankle and toes. Compression or irritation of this nerve, often near the knee or ankle, can lead to symptoms like foot drop (difficulty lifting the foot), pain, and tingling in the shin or top of the foot.
Arthritis within the ankle or foot joints can cause pain during dorsiflexion. Inflammation or degeneration of cartilage, which cushions joint surfaces, can cause bones to rub together. This leads to pain, stiffness, and reduced range of motion. It can affect any of the numerous joints in the foot and ankle, including those connecting the toes.
Pain when lifting the toes may also be referred from the lumbar spine. A pinched nerve in the lower back can radiate discomfort down the leg, sometimes manifesting as foot pain or difficulty with dorsiflexion. This pain originates in the spinal column but is felt in the foot due to nerve pathways.
Diagnosing the Source of Pain
Healthcare professionals diagnose pain by taking a medical history, asking about pain nature, onset, and aggravating or relieving factors. This is followed by a physical examination where the doctor observes gait, palpates affected areas for tenderness or swelling, and assesses foot and ankle range of motion and strength. Specific maneuvers, like checking for foot drop or assessing muscle strength during dorsiflexion, help pinpoint affected structures.
Imaging studies are often used to identify the underlying issue. X-rays can identify bone abnormalities, fractures, or signs of arthritis. Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues, including tendons, ligaments, and nerves, revealing inflammation or damage. Ultrasound may also visualize tendons and detect inflammation.
If nerve involvement is suspected, nerve conduction studies (NCS) and electromyography (EMG) may be performed. NCS measures how quickly electrical impulses travel through nerves, identifying nerve damage or compression. EMG assesses muscle electrical activity, indicating if a muscle is not functioning correctly due to a nerve problem.
Treatment and Management Approaches
Initial treatment for pain when lifting toes involves conservative measures. Rest and activity modification reduce stress on the affected area. Applying ice or heat can alleviate pain and inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may also manage discomfort.
Physical therapy is important for recovery, providing targeted exercises to improve strength, flexibility, and range of motion. Therapists use stretching, manual therapy, and modalities to reduce pain and restore function. Exercises may include toe raises, heel walks, and resistance band exercises to strengthen the tibialis anterior and other dorsiflexor muscles.
Supportive footwear and custom orthotics provide arch support, cushioning, and reduce strain on foot and ankle structures. Loosening shoelaces or wearing wider shoes can also relieve pressure on inflamed extensor tendons.
For localized inflammation, corticosteroid injections may reduce pain and swelling. Nerve blocks can be considered for specific nerve pain. Surgical intervention is typically a last resort for cases not responding to conservative treatments, especially for nerve decompression or severe tendon and joint issues.
When to Seek Professional Medical Advice
Seek professional medical advice if pain when lifting your toes is persistent or worsening, especially if it doesn’t improve after a few days or weeks of self-care. A sudden onset of severe pain, particularly after an injury, warrants prompt evaluation.
Additional symptoms like numbness, tingling, or weakness in the foot or toes indicate potential nerve involvement and require a doctor’s attention. Difficulty walking or developing a “foot drop” gait also signals significant muscle or nerve impairment. Visible deformity or significant swelling around the foot or ankle also necessitates medical consultation.