Pain on top of foot after running: common causes and when to get it checked

What causes pain on top of the foot after running?

The NHS lists exercise (especially running, kicking or jumping), shoes that are too tight, and conditions such as gout as the common causes (NHS, 2025).

Extensor tendinitis (irritated tendons)

The tendons that lift your toes and foot run across the top of the foot, right under your laces. Irritation of these is often called extensor tendinitis. The NHS describes tendon problems here as long-lasting pain, swelling and stiffness, sometimes with a grating feeling when you move or a lump along a tendon (NHS, 2025). Laces pulled tight over a sore spot are worth checking first.

Metatarsal stress fracture

The metatarsals are the five long bones running to the base of the toes, and most foot stress fractures happen here. They come from loading a bone faster than it can repair itself (University Hospitals Sussex NHS Foundation Trust, 2026).

A 2024 review of 32 studies found long-distance running is most often linked with fractures of the second or third metatarsal, and that high training intensity, training that is not built up gradually and inadequate equipment all raise the risk (Sun et al., 2024).

Navicular stress fracture

The navicular is a bone on the top, inner side of the midfoot. Stress fractures here are uncommon but are treated as high risk because they can be slow to heal. They tend to cause vague, activity-related midfoot pain with tenderness over the top of the bone, are easily missed, and often don't show on early X-rays (Younis et al., 2025).

When the big toe hurts on top

Pain and stiffness in the big toe joint, especially when the toe bends upwards, can be hallux rigidus, which is arthritis of the big toe joint. A bony lump can form on top of the joint and rub on your shoes. Shoes with a deeper toe box and a stiffer sole can help (Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

Gout causes sudden, severe pain in a joint, most often the big toe, with hot, swollen, red skin over it (NHS, 2023). It isn't a running injury, but it is easy to blame on a run. If you have these symptoms for the first time, see your GP.

Other causes include a sprain or strain, and sciatica, which can cause tingling, numbness or pain on top of the foot that spreads up the back of the leg (NHS, 2025).

Sore tendon or stress fracture? Clues to look for

You can't reliably tell these apart yourself, and the NHS advises against trying to diagnose foot pain on your own (NHS, 2025). Still, some patterns make a bone problem more or less likely.

Sources: NHS (2025); University Hospitals Sussex NHS Foundation Trust (2026).

What to do in the first two weeks

If there are no signs of a break (see the urgent signs below), the NHS self-help advice for pain on top of the foot is (NHS, 2025):

• Stop the running or activity you think is causing it for now.
• Rest and raise your foot when you can.
• Use an ice pack, or frozen peas wrapped in a towel, for up to 20 minutes every 2 to 3 hours.
• Wear roomy shoes with a low heel and soft sole, and avoid tight shoes.
• Take paracetamol or ibuprofen (tablets or gel) if they are suitable for you.

Get it assessed if the pain stops you doing normal activities, is getting worse or keeps coming back, hasn't improved after 2 weeks of home treatment, or comes with tingling or loss of feeling. If you have diabetes, get any foot pain checked, as foot problems can be more serious (NHS, 2025). Our foot and ankle pain treatment page explains how we help.

Why a suspected stress fracture needs checking

A stress fracture isn't something to run through. Healing usually takes 6 weeks to 6 months, pain can last up to 6 months, and getting back to high impact activity such as running can take up to a year. Treatment usually means taking weight off the foot, sometimes with a boot or crutches, and pausing the activity that caused it. Swimming or cycling can keep you fit meanwhile (University Hospitals Sussex NHS Foundation Trust, 2026).

Diagnosis can be tricky, because a stress fracture may not show on an early X-ray (University Hospitals Sussex NHS Foundation Trust, 2026). In a pilot study of 37 people with pain and swelling in the metatarsals and normal X-rays, ultrasound picked up 83% of the stress fractures that MRI found. It also gave some false alarms, and most people in the study were middle-aged women rather than runners, so ultrasound is a useful first look rather than the final word (Banal et al., 2009). We offer diagnostic ultrasound scans from £80. If the picture is still unclear, other imaging such as MRI may be needed.

Other risk factors include eating disorders, low bone density and having been through the menopause (University Hospitals Sussex NHS Foundation Trust, 2026). If you have had more than one stress fracture, it is worth discussing these with your GP as well as looking at your training.

Getting back to running

A 2021 review describes every bone stress injury in runners as an error in workload: the number and size of the loads on a bone outstripping its ability to cope. The authors recommend progressing training sensibly, particularly intensity. For runners who have had repeated bone stress injuries, they suggest considering ways to reduce the load on the bone, such as increasing running cadence (Warden, Edwards and Willy, 2021).

After a foot stress fracture, one NHS trust advises waiting until symptoms have settled, after about 6 weeks, then building up lower impact sport slowly, increasing one thing at a time (such as time or speed) by about 10% per session and not pushing through pain (University Hospitals Sussex NHS Foundation Trust, 2026). Our back to running guide sets out a staged return. If the problem keeps coming back, gait analysis (£150) looks at your cadence and how your feet take load when you run.

Frequently asked questions

Why does the top of my foot hurt after running?

The most common reasons are irritated tendons across the top of the foot (often called extensor tendinitis), shoes or laces that are too tight, and doing too much too soon. Less often it is a stress fracture in one of the metatarsal bones. Pain on top of the foot usually improves within a few weeks, but get it checked if it is severe, getting worse or not better after 2 weeks.

Can I keep running with pain on top of my foot?

It is best to stop the running that is causing it for now. NHS advice is to rest, raise the foot, use ice and wear roomy, soft-soled shoes. Swimming, cycling or walking on even ground can keep you active. Running through a possible stress fracture can turn a short break into months out, so if the pain builds with every run, get it assessed first.

How do I know if I have a metatarsal stress fracture?

Typical signs are a dull pain in the forefoot that gets worse with activity or weight bearing and eases with rest, swelling, and more pain when you press directly on the bone. It often follows a sudden increase in training, new shoes or a return after a break. You cannot confirm it yourself, so get it assessed, as it may not show on an early X-ray.

Why does my big toe hurt on top?

Pain and stiffness in the big toe joint, especially when the toe bends upwards, can be hallux rigidus, which is arthritis of the joint, sometimes with a bony lump on top that rubs on shoes. Sudden, severe pain with a hot, red, swollen joint is more typical of gout. If you have gout symptoms for the first time, see your GP.

Will a stress fracture in my foot show on an X-ray?

Not always. Stress fractures may not show on an early X-ray, and changes sometimes only appear on a later one. Other imaging can help. In one small study of people with metatarsal pain and normal X-rays, ultrasound picked up 83% of the stress fractures found on MRI, so it can be a useful first look, but MRI is sometimes still needed.