Barefoot Running Injuries: Top of Foot Pain

One of the most common barefoot running injuries is top of foot pain. How does this happen? One suggestion is that you might be over-engaging your toes during the push-off phase of running gait. That is, you may be using your toes too aggressively to launch your body forward at each step.

Turns out that solely using your toes for propulsion during running may result in aberrant plantar nerve connectivity, resulting in toe pain and injury. In simple terms, forcefully using your toes for push-off may hyper-stretch the nerve fibers that line the toes and forefoot.

Barefoot Running Injuries: Top of Foot Pain

Barefoot Running Injuries: Top of Foot Pain

In my opinion, aggressive toe push-off to initiate flight during running is a common mechanical trait of heel strike running because it is the only mechanism that drives forward momentum since most heel strike runners fail to use their torso to drive sustained forward momentum. For instance, most heel strike runners run too upright with their upper body, resulting in a torso posture lagging behind initial foot strike position, therefore more work may be needed from the knee and foot to pull the body forward.

  • In heel strike running, the center of mass is kept posteriorly relative to foot strike position.
  • To keep the center of mass traveling forward, the foot rolls heel to toe, then the toes propel the body forward.
  • The downside of this is the foot is in an extreme position that affects the conduction properties of the peripheral nerves in the feet.
Barefoot Running Injuries: Top of Foot Pain
This is an example of toe-propulsion to initiate flight during running. The toes are overloaded when used to propel the entire mass of the body. Nerve fibers are stretched and compressed during the process. SOURCE: Peck et al. Neuropathy in runners (fig 2.) Clin Sports Med, 2010 (29):437-457

A study by Smith and Dahm (2001) observed that toe propulsion was facilitated by extreme toe dorsiflexion (shown above) which may compress, stretch and demyelinate the plantar interdigital nerve located under the intermetatarsal ligament.

Most nerves have myelinated (myelin sheath) axons –a component of the nerve which sends signals to another nerve. The myelin sheath is important for optimal conduction velocity of nerve signals –the thicker the myelin sheath, the faster, more secure a signal is.

  • When there are disruptions in the myelin sheath (i.e. demyelination), signal velocity is significantly delayed or blocked, therefore the central nervous system misses out on information from the affected area.

Overall, toe propulsion leads to low or aberrant nerve connectivity in the feet, but subsequently all the stresses and straining from forceful toe dorsiflexion leads to interdigital neuroma due to entrapment of the interdigital nerve.

How to Avoid Toe Injury

To prevent toe injury from running, ease up on toe propulsion whereby running barefoot will allow for helpful adaptions in achieving this.

Habitual forefoot runners, especially those who run barefoot, don’t experience foot/toe nerve entrapment injuries because these runners don’t use their toes for propulsion in the same way heel strike runners do. This is where I feel Pose Running comes in handy because you learn quickly not to push, but to pull.

Toe Pain Running
Very minimal toe pushing shown above. Let the foot ‘slip’ out from under you meanwhile keep your center of mass pushing forward.

Because the center of mass is anterior relative to foot strike position in forefoot running, toe propulsion is not needed to drive forward momentum, rather it is the combination of finding the right degree of forward tilt and learning to use your foot passively with the ground by letting the spring-action in the leg remove the foot off the ground behind the body.

To coordinate this with success, wear zero drop running shoes with a hard midsole.

Why not wear soft, cushy running shoes? Detecting the position of your center of mass can be felt by sensing the center of pressure in the foot. You want to feel the center of pressure under the toes (i.e. the balls of your feet).

Running shoes that are ‘barefoot-like’ however, are vital for improving foot strike mechanics because they allow physical reality to closely match the perception of foot strike awareness. This enables you to accurately gauge your position of center of mass relative to your foot strike, helping you pull, not push with your feet.

More From Run Forefoot:

How to Gain More Endurance for Running

Best Running Shoes for Midfoot Runners

Why Forefoot Running is Better

Best Shoes for Forefoot Running 

Benefits of Barefoot Running


Baxter D. Functional nerve disorders in the athlete’s foot, ankle and leg. Instr Course Lect 1993;42:185–94.

Peck et al. Neuropathy in runners. Clin Sports Med, 2010 (29):437-457.

Smith J, Dahm D. Nerve entrapments. In: O’Connor F, Wilder R, editors. The textbook of running medicine. New York: McGraw-Hill; 2001. p. 257–72.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

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P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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