Differential Diagnoses for Dorsal Foot Pain

Primary Musculoskeletal Differentials

The American College of Radiology recommends considering extensor tendonitis as a cause of dorsal foot pain, which worsens with active toe extension or resisted dorsiflexion, with point tenderness localizing along the extensor tendons running across the dorsal surface 1
Stress fractures of the metatarsals, navicular, cuboid, or cuneiform bones are common in runners and athletes, with initial radiographs detecting only 12-56% of stress fractures 2, 3, 1, 4

The Journal of the American College of Radiology states that tarsal coalitions cause chronic midfoot pain, with radiographs showing 80-100% sensitivity for calcaneonavicular and 100% sensitivity for talocalcaneal coalitions 4, 2

Osteoarthritis of the tarsometatarsal or midtarsal joints causes dorsal foot pain that worsens with weight-bearing and dorsiflexion, according to the American College of Radiology 1
Freiberg's infraction presents with localized dorsal forefoot pain, as reported by the Journal of the American College of Radiology 4, 2

The American College of Radiology recommends obtaining weight-bearing radiographs as the first imaging study for all patients with dorsal foot pain 5, 6, 1, 3
The Journal of the American College of Radiology suggests that MRI without contrast or CT without contrast are equivalent alternatives for detecting stress fractures 1, 3
A three-phase bone scan has 100% sensitivity and negative predictive value for ruling out stress fractures when radiographs are negative, according to the Journal of the American College of Radiology 5, 3

The American College of Radiology advises against relying solely on initial radiographs to exclude stress fractures, given the 12-56% sensitivity 1, 2
The American College of Radiology recommends avoiding corticosteroid injections near extensor tendons due to the risk of tendon rupture 1