Member Case Study: Top of Foot Pain

author : AMSSM

comments : 0

I sometimes have severe pains on the top of my left foot. It feels like a knife is stabbing my inner foot on the outer portion of my foot. These pains happen mainly at night but not while riding.

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Member Question from recon110

"I sometimes have severe pains on the top of my left foot. It feels like a knife is stabbing my inner foot on the outer portion of my foot. I have some varicose veins as my mom and dad had. These pains happen mainly at night and sometimes while driving but never while riding my properly fitted QR Kilo. Please direct me to the source of my pains."
 
Answer from Andy Peterson, MD

Member AMSSM

Pain in the top of the foot is a common complaint among ice skaters, hockey players and others who use tight fitting footwear. In these athletes, the condition is known as “lace bite” or “skate bite.” It is caused by direct irritation of the skate or shoe to the soft tissues on the top of the foot. It is typically worse when wearing the offending footwear, but can be tender or sensitive at other times. This condition responds very well to changing the lacing pattern, padding the top of the foot, modifying the footwear or changing to better fitting footwear. Lace bite is relatively uncommon in cyclists and triathletes, but can be seen with new or poorly fitting shoes or if the shoes are worn either too tight or tightened unevenly.

Other possibilities include injuries to the bones or joints in the feet, such as a metatarsal stress fracture, tarsal coalition or arthritis. Nerve injuries, either from your back or farther down your leg can cause foot pain, as can rheumatologic diseases such as rheumatoid arthritis. Abnormalities in the tendons on the top of the foot such as extensor tendon tendinosis or a ganglion cyst can also cause pain. These conditions usually require evaluation by a medical professional for proper evaluation and treatment.

In your case, I would consider padding the top of your foot during training and while wearing your casual and work shoes. In addition, re-evaluate the lacing pattern on all of your shoes and the closure mechanism on your cycling shoes to make sure that they are not too tight and that they distribute pressure evenly over the top of your foot. If this does not solve your problem rather quickly, I would recommend that you see your medical provider. It may take more sophisticated imaging and diagnostic tests to make the diagnosis.

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date: August 24, 2009