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Pain in the instep of the foot: causes and treatment

Anatomically, the instep is the dorsal area or the upper part of the foot, is composed of 28 bones and 9 extensor tendons that come from the leg. This particular area may be affected usually due to the impact it receives when walking or performing different activities, especially because it is an exposed area it is estimated that it must support an equivalent to 2 times our body weight.

The most common causes related to pain in the instep are tendonitis and pain due to bone deformity, such as cavus foot and flat foot. If you want to know more about the pain in the instep of the foot: causes and treatment , we invite you to continue reading this article.


Anatomy of the foot

The foot has a special structure that allows the standing and mobility to human being, likewise its structure can support almost twice the body weight. The feet:

  1. They act as a shock absorber.
  2. They allow to maintain balance.
  3. They provide us with all the necessary characteristics to walk, run, jump.

Anatomically, the instep is located on the top of the foot. It is composed of 28 bones and corresponds particularly to the bones:

  • Scaphoid.
  • First wedge.
  • Second wedge.
  • Third wedge.
  • Cuboid.
  • Metatarsals

On the other hand, it has 9 extensor tendons that allow you to pull the toes upwards and that come from the leg. Two tendons for each finger from the first to the fourth finger and a tendon for the fifth finger.


Causes of pain in the instep of the foot

Once the complex structure of the instep of the foot is known, many causes related to pain that may occur in this area must be taken into consideration. Among the causes of pain in the instep of the most common feet, we find:

Tendinitis in the foot

A common condition that can present pain in the instep of the foot is known as tendonitis , which is the inflammation of some of the extensor tendons that make up this complex structure of the foot.

Tendinitis is usually caused by overloading of a muscle near the tendon due to the use of shoes that are too narrow.

In addition to the pain resulting from the inflammatory process of the tendon, tendinitis can manifest itself with: swelling in the instep, discomfort when wearing and a symptom, which allows the doctor to diagnose this condition, which is known as crepitus of the tendon, a kind of snap when extending or flexing the toes.


The loss of the normal continuity of a bone can be due to a blow to the foot or due to an unknown cause, which is known as a stress fracture. Generally, the fracture in this area occurs in one of the metatarsals and this type of fracture is related to:

  1. Overload on the foot.
  2. Muscular weakness.
  3. Increase in the level of daily activity.
  4. Abrupt exercise.
  5. Sedentary.
  6. After being inactive.

Pie dig

This occurs when there is an abnormal lift of the instep , in addition, the toes may be bent inwards. With this condition, there is a prominent instep with well marked muscle and tendon retraction, in this way, the wedges are tensed.

A large percentage of people suffering from this foot syndrome are related to a basic neurological disease.

The initial form with which this condition manifests is with pain in the instep of the foot, likewise pain appears in the heel, forefoot and under the fingers, shortening of the foot length, difficulty in using footwear, pain when remaining of walking or walking


In this case, the instep is somehow sunken, the wedges are compacted, approaching more than normal and causing a collapse in this area.

The pain that can occur is after the completion of some specific activity. Likewise, the person with flat feet can manifest:

  • Clumsiness when walking.
  • Constant falls.
  • Sensitivity.
  • Frequent cramps.

Tarsus sinus syndrome

The sinus of the tarsus is a kind of channel that is located between the heel bone and the ankle, through which run ligaments, blood vessels and nerves. This syndrome is caused by a forced trauma due to a sprain of the foot inwards or as a result of a sprained ankle. It may also be related to repetitive exercises, such as baseball or ballet.

The tarsal sinus syndrome is characterized by pain in the upper part of the foot due to the inflammatory and irritative process of this area. It is likely that upon awakening the ankle is rigid and limited to the movements that are progressively giving way.


In this case, it is a bony deformity of one or more toes that bend downward. Its cause is related to the use of footwear of smaller size than the corresponding one, the use of shoes with sharp toe or by some predisposing alteration at muscular level.

The pain of having a hammer finger is usually intense and tends to aggravate after the appearance of calluses that may form due to this typical position of the fingers.


Gout is a rheumatic disease characterized by the formation of uric acid crystals in tissues and joints. This triggers a kind of inflammatory response in the most distant places of the body, that is, the extremities. The foot is usually an area of ??common affectation, especially, the hallux finger of the foot or the big toe.

Although this condition affects the joints of the fingers, if the inflammatory process is of great magnitude, the pain extends to the instep of the foot. The pain is acute and increases especially at night, that is, when they are usually at rest.

Usually, gout appears due to diabetes mellitus, obesity, genetic predisposition or a diet rich in purines, that is, in meats.

Pain from nervous entrapment

This is due to a compression of some nerve branch by some anatomical structure of the foot, whether bone or muscle. The causes are varied, generally, by the use of tight shoes or by some traumatism on the foot.

Characteristically, pain appears in the instep, punctures and numbness.

Pain due to ganglion cyst

In the area of ??the instep, a kind of swelling of liquid content may appear , usually caused by some injury that conditions the exit of this joint fluid. Consequently, it accumulates in the soft tissues, forming what is known as ganglionic instep cyst.

The protrusion is usually painful and of variable size, from the size of a pea to the size of a golf ball.

Foot fungus

Occasionally, the foot can be affected by a fungal infection , which can occur on any part of the skin but, above all, in moist regions such as between the toes.

This fungal affection can cause the appearance of pain between the fingers until extending to the instep, both in the lateral zones and in the upper face, as well as peeling of the skin and even infection of the same due to intense scratching.

Pain by tarsal coalition

It is the union between the bones of the tarsus. It is a congenital problem and can cause pain, stiffness and instability in the foot.



Pain in the instep of the foot: medical treatment

Given the different causes, the doctor must make the diagnosis to individualize the treatment of pain in the instep of the foot , which may include:

  1. Treatment with non-steroidal anti-inflammatories, such as diclofenac or ibuprofen to relieve pain and instep of the inflamed foot, these can be topical or oral.
  2. Rest until the pain disappears, it is recommended to place the foot high to improve circulation.
  3. Avoid pressure on the instep, wearing shoes that fit and comfortable.
  4. Perform physiotherapy to strengthen the tendons of the foot.
  5. Sometimes, the use of a bandage is necessary.
  6. Use crutches to avoid weight in the injured foot.
  7. Use orthopedic pads on shoes to have better support and avoid standing sprains.
  8. Ultrasound or electrotherapy can be indicated to reduce inflammation.
  9. The doctor can indicate exercises for muscle training, whether strengthening or stretching.
  10. Swimming can be indicated to improve the movement of the joints.
  11. Surgical intervention is indicated when necessary, for example, in the case of ganglion cyst and hammer toe.


How to relieve pain in the instep of the foot

To relieve pain in the instep of the foot you can easily use the following measures until the doctor assesses you:

  • RICE method is the most used: rest, ice, compression and elevation of the affected limb. especially ice is responsible for vasoconstriction and therefore reduces pain and inflammation.
  • You can use lukewarm water baths with a tablespoon of salt alternated with cold water, you must first place your feet in the warm water for 3 minutes and then in the cold water. This method allows you to relax your feet and reduce inflammation.
  • Perform stretching massage with a bottle from the heel to the fingers for 10 minutes and repeat it every hour until the pain has disappeared.
  • Perform massages with moisturizing cream or oils such as argan, rose or almond.
  • Do not wear footwear, go barefoot at home, on a flat surface. This will strengthen and tone the feet.
  • Chamomile tea has anti-inflammatory properties, you can take it to soothe the pain in the instep or perform a massage with the tea on the top of the foot.
  • You can also use massages or baths with sage, thyme or rosemary for pain.

This article is purely informative, in we do not have the faculty to prescribe medical treatments or make any type of diagnosis. We invite you to go to a doctor in case of presenting any type of condition or discomfort.

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